Provider Demographics
NPI:1942559604
Name:MA, RICHARD (PHARM D)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:MA
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8619 ASHTON PL NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87122-2684
Mailing Address - Country:US
Mailing Address - Phone:505-620-1942
Mailing Address - Fax:
Practice Address - Street 1:5850 EUBANK BLVD NE STE A1
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-6132
Practice Address - Country:US
Practice Address - Phone:505-217-2818
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-09
Last Update Date:2012-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRP00007882183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist