Provider Demographics
NPI:1912207127
Name:BARTHOLOMEW, RICHARD LEE (RPH)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:LEE
Last Name:BARTHOLOMEW
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 COURTYARD LN
Mailing Address - Street 2:
Mailing Address - City:BARBOURSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:25504-1015
Mailing Address - Country:US
Mailing Address - Phone:304-412-2557
Mailing Address - Fax:304-733-9503
Practice Address - Street 1:22 COURTYARD LN
Practice Address - Street 2:
Practice Address - City:BARBOURSVILLE
Practice Address - State:WV
Practice Address - Zip Code:25504-1015
Practice Address - Country:US
Practice Address - Phone:304-412-2557
Practice Address - Fax:304-733-9503
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-22
Last Update Date:2010-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2739183500000X
OH03309637183500000X
KY010211183500000X
NC09475183500000X
SCPH.6633 PH183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist