Provider Demographics
NPI:1972639136
Name:MAVES, RICHARD ALLEN JR (RPH)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:ALLEN
Last Name:MAVES
Suffix:JR
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 1:2547 GODDARD RD
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43606-3210
Mailing Address - Country:US
Mailing Address - Phone:419-512-4038
Mailing Address - Fax:419-691-5732
Practice Address - Street 1:210 MAIN ST
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43605-2036
Practice Address - Country:US
Practice Address - Phone:419-691-5851
Practice Address - Fax:419-691-5732
Is Sole Proprietor?:No
Enumeration Date:2007-02-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-3-25238183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist