Provider Demographics
NPI:1154421808
Name:RICHARDS, CASSANDRA BUCKHANAN (RPH)
Entity type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:BUCKHANAN
Last Name:RICHARDS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:MS
Other - First Name:CASSANDRA
Other - Middle Name:FAYE
Other - Last Name:BUCKHANAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RPH
Mailing Address - Street 1:5935 BRAELOCH DR
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71129-5101
Mailing Address - Country:US
Mailing Address - Phone:318-688-9775
Mailing Address - Fax:
Practice Address - Street 1:510 E STONER AVE
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71101-4243
Practice Address - Country:US
Practice Address - Phone:318-424-6001
Practice Address - Fax:318-429-5750
Is Sole Proprietor?:No
Enumeration Date:2006-09-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA14717183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist