Provider Demographics
NPI:1972706752
Name:RICHMOND, MARK A (RPH)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:A
Last Name:RICHMOND
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 1:731 CENTER ST
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:NY
Mailing Address - Zip Code:14092-1705
Mailing Address - Country:US
Mailing Address - Phone:716-754-9201
Mailing Address - Fax:716-754-8971
Practice Address - Street 1:731 CENTER ST
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:NY
Practice Address - Zip Code:14092-1705
Practice Address - Country:US
Practice Address - Phone:716-754-9201
Practice Address - Fax:716-754-8971
Is Sole Proprietor?:No
Enumeration Date:2007-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY048587183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist