Provider Demographics
NPI:1942437512
Name:RICHARD, PHILIP DORR (RPH)
Entity Type:Individual
Prefix:MR
First Name:PHILIP
Middle Name:DORR
Last Name:RICHARD
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:BOX 850
Mailing Address - Street 2:4053 LANKFORD HIGHWAY
Mailing Address - City:EXMORE
Mailing Address - State:VA
Mailing Address - Zip Code:23350
Mailing Address - Country:US
Mailing Address - Phone:757-442-8542
Mailing Address - Fax:757-442-3448
Practice Address - Street 1:4053 LANKFORD HIGHWAY
Practice Address - Street 2:
Practice Address - City:EXMORE
Practice Address - State:VA
Practice Address - Zip Code:23350
Practice Address - Country:US
Practice Address - Phone:757-442-8542
Practice Address - Fax:757-442-3448
Is Sole Proprietor?:No
Enumeration Date:2009-06-22
Last Update Date:2009-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202004237183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist