Provider Demographics
NPI:1235953639
Name:RICHMOND, HAIDEN BREE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:HAIDEN
Middle Name:BREE
Last Name:RICHMOND
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1221 MAIN ST # 1059
Mailing Address - Street 2:
Mailing Address - City:THOMPSON FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59873-9355
Mailing Address - Country:US
Mailing Address - Phone:406-827-9640
Mailing Address - Fax:
Practice Address - Street 1:1221 MAIN ST
Practice Address - Street 2:
Practice Address - City:THOMPSON FALLS
Practice Address - State:MT
Practice Address - Zip Code:59873-9355
Practice Address - Country:US
Practice Address - Phone:406-827-9640
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-12
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTPHA-PHA-LIC-111122183500000X
KS1-123082183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist