Provider Demographics
NPI:1902010820
Name:MCMAHAN, RICHARD K
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:K
Last Name:MCMAHAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 N HARRIS DR
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERS
Mailing Address - State:MO
Mailing Address - Zip Code:63376-3504
Mailing Address - Country:US
Mailing Address - Phone:636-397-2169
Mailing Address - Fax:
Practice Address - Street 1:12137 BRIDGETON SQ
Practice Address - Street 2:
Practice Address - City:BRIDGETON
Practice Address - State:MO
Practice Address - Zip Code:63044-2616
Practice Address - Country:US
Practice Address - Phone:314-291-5700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO044134183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist