Provider Demographics
NPI:1457981441
Name:RICHARDSON, GEORGE ELWOOD III
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:ELWOOD
Last Name:RICHARDSON
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15262 RUSSELL DR
Mailing Address - Street 2:
Mailing Address - City:ONANCOCK
Mailing Address - State:VA
Mailing Address - Zip Code:23417-3004
Mailing Address - Country:US
Mailing Address - Phone:410-713-0279
Mailing Address - Fax:
Practice Address - Street 1:106 MILFORD ST STE 401
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21804-6964
Practice Address - Country:US
Practice Address - Phone:410-860-0700
Practice Address - Fax:410-860-0079
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-19
Last Update Date:2020-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD9172183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist