Provider Demographics
NPI:1902239759
Name:RICHARDSON, ANN C (DPH)
Entity Type:Individual
Prefix:MRS
First Name:ANN
Middle Name:C
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:DPH
Other - Prefix:MRS
Other - First Name:JESSIE
Other - Middle Name:A
Other - Last Name:RICHARDSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DPH
Mailing Address - Street 1:1201 DINAH SHORE BLVD
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:TN
Mailing Address - Zip Code:37398
Mailing Address - Country:US
Mailing Address - Phone:931-967-2777
Mailing Address - Fax:931-967-1264
Practice Address - Street 1:1201 DINAH SHORE BLVD
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:TN
Practice Address - Zip Code:37398
Practice Address - Country:US
Practice Address - Phone:931-967-2777
Practice Address - Fax:931-967-1264
Is Sole Proprietor?:No
Enumeration Date:2013-08-15
Last Update Date:2013-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNC3124183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist