Provider Demographics
NPI:1104470152
Name:RICHMOND, SHAWNA KRISTYNE (PHARMD)
Entity type:Individual
Prefix:
First Name:SHAWNA
Middle Name:KRISTYNE
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 1:266 OLD CLINE RD
Mailing Address - Street 2:
Mailing Address - City:GHENT
Mailing Address - State:WV
Mailing Address - Zip Code:25843-9348
Mailing Address - Country:US
Mailing Address - Phone:304-237-4431
Mailing Address - Fax:
Practice Address - Street 1:159 BEAVER PLZ
Practice Address - Street 2:
Practice Address - City:BEAVER
Practice Address - State:WV
Practice Address - Zip Code:25813-8400
Practice Address - Country:US
Practice Address - Phone:304-255-6630
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-29
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVRP0011137183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist