Provider Demographics
NPI:1952757270
Name:NELSON, RICHARD (RPH)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:NELSON
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 1:1603 BIG OAK RD
Mailing Address - Street 2:
Mailing Address - City:YARDLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19067-6418
Mailing Address - Country:US
Mailing Address - Phone:215-595-0080
Mailing Address - Fax:
Practice Address - Street 1:1603 BIG OAK RD
Practice Address - Street 2:
Practice Address - City:YARDLEY
Practice Address - State:PA
Practice Address - Zip Code:19067-6418
Practice Address - Country:US
Practice Address - Phone:215-595-0080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-05
Last Update Date:2016-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03118200183500000X
OK8843183500000X
PARP440365183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist