Provider Demographics
NPI:1245877406
Name:RICHEY MEDICAL PHARMACY, LLC
Entity type:Organization
Organization Name:RICHEY MEDICAL PHARMACY, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/ PHARMACIST IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARCOS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:813-431-1718
Mailing Address - Street 1:4939 FLORAMAR TER APT 207
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34652-3303
Mailing Address - Country:US
Mailing Address - Phone:813-431-1718
Mailing Address - Fax:
Practice Address - Street 1:5346 GRAND BLVD
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34652-4012
Practice Address - Country:US
Practice Address - Phone:727-807-5344
Practice Address - Fax:727-807-6320
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-06
Last Update Date:2020-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL105880500Medicaid