Provider Demographics
NPI:1871873364
Name:RICHARDS, BRIAN W (RPH)
Entity type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:W
Last Name:RICHARDS
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:8636 RAHKE RD
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46217-5083
Mailing Address - Country:US
Mailing Address - Phone:317-881-3389
Mailing Address - Fax:317-788-6716
Practice Address - Street 1:455 E EPLER AVE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46227-1902
Practice Address - Country:US
Practice Address - Phone:317-788-6671
Practice Address - Fax:317-788-6716
Is Sole Proprietor?:No
Enumeration Date:2011-08-28
Last Update Date:2011-08-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN26015779A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist