Provider Demographics
NPI:1831242957
Name:OFFENHAUSER, RICHARD L (RPH)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:L
Last Name:OFFENHAUSER
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1033 OAK TERRACE DR
Mailing Address - Street 2:
Mailing Address - City:NORTH MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56003-3424
Mailing Address - Country:US
Mailing Address - Phone:507-345-5722
Mailing Address - Fax:
Practice Address - Street 1:418 1ST AVE S
Practice Address - Street 2:
Practice Address - City:SAINT JAMES
Practice Address - State:MN
Practice Address - Zip Code:56081-1726
Practice Address - Country:US
Practice Address - Phone:507-375-4511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN111317-4183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist