Provider Demographics
NPI:1255875233
Name:RICHARDSON, DUANE ANTHONY (PHARM D)
Entity type:Individual
Prefix:
First Name:DUANE
Middle Name:ANTHONY
Last Name:RICHARDSON
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:623 SEDGEWICK DR
Mailing Address - Street 2:
Mailing Address - City:MAGNOLIA
Mailing Address - State:DE
Mailing Address - Zip Code:19962-3207
Mailing Address - Country:US
Mailing Address - Phone:267-235-2664
Mailing Address - Fax:
Practice Address - Street 1:623 SEDGEWICK DR
Practice Address - Street 2:
Practice Address - City:MAGNOLIA
Practice Address - State:DE
Practice Address - Zip Code:19962-3207
Practice Address - Country:US
Practice Address - Phone:267-235-2664
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-12
Last Update Date:2016-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEA1-0003619183500000X
PARP440333183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE240705OtherNABP
PARP440333OtherPHARMACY LICENSE
DEA1-0003619OtherPHARMACY LICENSE