Provider Demographics
NPI:1063719466
Name:RICHMOND, KATINA (PHARMD)
Entity type:Individual
Prefix:DR
First Name:KATINA
Middle Name:
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 1:186 JESSICA LAKES DR
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:SC
Mailing Address - Zip Code:29526-8292
Mailing Address - Country:US
Mailing Address - Phone:843-465-1556
Mailing Address - Fax:843-347-3177
Practice Address - Street 1:4779 HIGHWAY 501
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29579-9444
Practice Address - Country:US
Practice Address - Phone:843-903-5695
Practice Address - Fax:843-903-4820
Is Sole Proprietor?:No
Enumeration Date:2011-02-21
Last Update Date:2021-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC10596183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist