Provider Demographics
NPI:1902392756
Name:RICHARDS, REBECCA CLAIRE
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:CLAIRE
Last Name:RICHARDS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 S BELLS ST
Mailing Address - Street 2:
Mailing Address - City:ALAMO
Mailing Address - State:TN
Mailing Address - Zip Code:38001-1768
Mailing Address - Country:US
Mailing Address - Phone:731-696-5400
Mailing Address - Fax:731-696-5405
Practice Address - Street 1:61 S BELLS ST
Practice Address - Street 2:
Practice Address - City:ALAMO
Practice Address - State:TN
Practice Address - Zip Code:38001-1768
Practice Address - Country:US
Practice Address - Phone:731-696-5400
Practice Address - Fax:731-696-5405
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-05
Last Update Date:2019-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN42177183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist