Provider Demographics
NPI:1922782879
Name:RICHARDSON, ELLIOT (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ELLIOT
Middle Name:
Last Name:RICHARDSON
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1135 BRENTWOOD PT
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:TN
Mailing Address - Zip Code:37763-3143
Mailing Address - Country:US
Mailing Address - Phone:931-349-1566
Mailing Address - Fax:
Practice Address - Street 1:768 S JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-4070
Practice Address - Country:US
Practice Address - Phone:931-526-7143
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-12
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN33425183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist