Provider Demographics
NPI:1902230691
Name:RICHARDS, BURRELL (PHARM D)
Entity Type:Individual
Prefix:
First Name:BURRELL
Middle Name:
Last Name:RICHARDS
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8774 W SURREY AVE
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381-6120
Mailing Address - Country:US
Mailing Address - Phone:801-645-0317
Mailing Address - Fax:
Practice Address - Street 1:1575 N DYSART RD
Practice Address - Street 2:
Practice Address - City:AVONDALE
Practice Address - State:AZ
Practice Address - Zip Code:85392-1204
Practice Address - Country:US
Practice Address - Phone:623-925-0851
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-29
Last Update Date:2013-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS020117183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist