Provider Demographics
NPI:1922256403
Name:HERILLA, J RICHARD (RPH)
Entity Type:Individual
Prefix:
First Name:J RICHARD
Middle Name:
Last Name:HERILLA
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 1:815 COLONIAL DR
Mailing Address - Street 2:
Mailing Address - City:BIRDSBORO
Mailing Address - State:PA
Mailing Address - Zip Code:19508-2237
Mailing Address - Country:US
Mailing Address - Phone:610-582-1498
Mailing Address - Fax:610-582-1949
Practice Address - Street 1:815 COLONIAL DR
Practice Address - Street 2:
Practice Address - City:BIRDSBORO
Practice Address - State:PA
Practice Address - Zip Code:19508-2237
Practice Address - Country:US
Practice Address - Phone:610-582-1498
Practice Address - Fax:610-582-1949
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-08
Last Update Date:2008-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP025932L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist