Provider Demographics
NPI:1972129039
Name:ALSTON, RICHARD LEE III (LPN)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:LEE
Last Name:ALSTON
Suffix:III
Gender:M
Credentials:LPN
Other - Prefix:MR
Other - First Name:RICHARD
Other - Middle Name:LEE
Other - Last Name:ALSTON
Other - Suffix:III
Other - Last Name Type:Professional Name
Other - Credentials:LPN
Mailing Address - Street 1:1200 LAKE AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14613-1269
Mailing Address - Country:US
Mailing Address - Phone:585-642-5871
Mailing Address - Fax:
Practice Address - Street 1:1200 LAKE AVE APT 3
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14613-1269
Practice Address - Country:US
Practice Address - Phone:585-642-5871
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-24
Last Update Date:2020-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY337984164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYLPNMedicaid
NY337984Medicaid