Provider Demographics
NPI:1811433188
Name:RICHARDSON, CLARENCE MCNEIL VAUGHN JR (PHARMD, RPH)
Entity type:Individual
Prefix:MR
First Name:CLARENCE
Middle Name:MCNEIL VAUGHN
Last Name:RICHARDSON
Suffix:JR
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 1:1821 S VALLEY MILLS DR
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76711-2118
Mailing Address - Country:US
Mailing Address - Phone:254-757-3344
Mailing Address - Fax:
Practice Address - Street 1:1821 S VALLEY MILLS DR
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76711-2118
Practice Address - Country:US
Practice Address - Phone:254-757-3344
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-11
Last Update Date:2017-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX54807183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist