Provider Demographics
NPI:1972146785
Name:JESPERSEN, RICHARD (PHARMD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:JESPERSEN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 S BORDON ST
Mailing Address - Street 2:
Mailing Address - City:LORENA
Mailing Address - State:TX
Mailing Address - Zip Code:76655-9675
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5900 BOSQUE BLVD
Practice Address - Street 2:DRUG EMPORIUM
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76655
Practice Address - Country:US
Practice Address - Phone:254-772-0011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-24
Last Update Date:2019-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX44287183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist