Provider Demographics
NPI:1245309061
Name:RICHTER, RICHARD S (RPH)
Entity type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:S
Last Name:RICHTER
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:460 PALM COAST PARKWAY S.W.
Mailing Address - Street 2:SUITE 5
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32137
Mailing Address - Country:US
Mailing Address - Phone:386-246-3958
Mailing Address - Fax:386-246-3961
Practice Address - Street 1:460 PALM COAST PARKWAY S.W.
Practice Address - Street 2:SUITE 5
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32137
Practice Address - Country:US
Practice Address - Phone:386-246-3958
Practice Address - Fax:386-246-3961
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL14086183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist