Provider Demographics
NPI:1821258385
Name:RICHARDSON, KEVIN (PHARMD)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:
Last Name:RICHARDSON
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7887 N LA CHOLLA BLVD
Mailing Address - Street 2:APT #1026
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85741-4313
Mailing Address - Country:US
Mailing Address - Phone:520-395-1073
Mailing Address - Fax:
Practice Address - Street 1:7887 N LA CHOLLA BLVD
Practice Address - Street 2:APT #1026
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85741-4313
Practice Address - Country:US
Practice Address - Phone:520-395-1073
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-09
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ015678183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist