Provider Demographics
NPI:1942502554
Name:GARRETT, RICHARD TED
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:TED
Last Name:GARRETT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9351 ATLEE RD
Mailing Address - Street 2:
Mailing Address - City:MECHANICSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23116-2540
Mailing Address - Country:US
Mailing Address - Phone:804-569-8241
Mailing Address - Fax:804-569-8243
Practice Address - Street 1:9351 ATLEE RD
Practice Address - Street 2:
Practice Address - City:MECHANICSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23116-2540
Practice Address - Country:US
Practice Address - Phone:804-569-8241
Practice Address - Fax:804-569-8243
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-02
Last Update Date:2010-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202004458183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist