Provider Demographics
NPI:1972144574
Name:BIRD, RICHARD GLYNN (RPH)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:GLYNN
Last Name:BIRD
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:PO BOX 1829
Mailing Address - Street 2:
Mailing Address - City:OZONA
Mailing Address - State:TX
Mailing Address - Zip Code:76943-1829
Mailing Address - Country:US
Mailing Address - Phone:325-226-3100
Mailing Address - Fax:
Practice Address - Street 1:902 11TH ST
Practice Address - Street 2:
Practice Address - City:OZONA
Practice Address - State:TX
Practice Address - Zip Code:76943-1829
Practice Address - Country:US
Practice Address - Phone:325-392-2666
Practice Address - Fax:325-392-2864
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-04
Last Update Date:2019-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX22531183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist