Provider Demographics
NPI:1861089229
Name:RICHMOND, SANDRA JANE (RPH)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:JANE
Last Name:RICHMOND
Suffix:
Gender:F
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:PO BOX 53
Mailing Address - Street 2:
Mailing Address - City:GARRETTSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44231-0053
Mailing Address - Country:US
Mailing Address - Phone:330-527-4349
Mailing Address - Fax:330-527-5267
Practice Address - Street 1:8295 WINDHAM ST
Practice Address - Street 2:
Practice Address - City:GARRETTSVILLE
Practice Address - State:OH
Practice Address - Zip Code:44231-9406
Practice Address - Country:US
Practice Address - Phone:330-527-4349
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-30
Last Update Date:2020-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03318379183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist