Provider Demographics
NPI:1700341708
Name:GARCIA, RICHARD (PHARMD, RPH)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:GARCIA
Suffix:
Gender:M
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 151021
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49515-1021
Mailing Address - Country:US
Mailing Address - Phone:616-437-7353
Mailing Address - Fax:
Practice Address - Street 1:1148 28TH ST SW
Practice Address - Street 2:
Practice Address - City:WYOMING
Practice Address - State:MI
Practice Address - Zip Code:49509-2855
Practice Address - Country:US
Practice Address - Phone:616-724-1944
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-04
Last Update Date:2021-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53024130431835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5315221611OtherMICHIGAN LARA
MI5302413043OtherMICHIGAN LARA