Provider Demographics
NPI:1205965845
Name:NELSON, RICHARD LOREN (R PH)
Entity type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:LOREN
Last Name:NELSON
Suffix:
Gender:M
Credentials:R PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:172702 W BYRON RD
Mailing Address - Street 2:
Mailing Address - City:PROSSER
Mailing Address - State:WA
Mailing Address - Zip Code:99350-8544
Mailing Address - Country:US
Mailing Address - Phone:509-786-3237
Mailing Address - Fax:
Practice Address - Street 1:2010 YAKIMA VALLEY HWY STE C1
Practice Address - Street 2:
Practice Address - City:SUNNYSIDE
Practice Address - State:WA
Practice Address - Zip Code:98944-1289
Practice Address - Country:US
Practice Address - Phone:509-893-2711
Practice Address - Fax:509-839-4768
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00007504183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist