Provider Demographics
NPI:1912284191
Name:GAUDIAN, RICHARD ALAN (RPH)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:ALAN
Last Name:GAUDIAN
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 1:30776 STATE LN
Mailing Address - Street 2:
Mailing Address - City:NEOLA
Mailing Address - State:IA
Mailing Address - Zip Code:51559-6072
Mailing Address - Country:US
Mailing Address - Phone:712-485-2259
Mailing Address - Fax:
Practice Address - Street 1:301 W BENNETT AVE
Practice Address - Street 2:
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51503-5179
Practice Address - Country:US
Practice Address - Phone:712-325-0619
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-15
Last Update Date:2011-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA14543183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist