Provider Demographics
NPI:1194893537
Name:RICHARDS PHARMACY INC
Entity type:Organization
Organization Name:RICHARDS PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:J
Authorized Official - Last Name:RICHARDS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:515-274-4001
Mailing Address - Street 1:5625 HICKMAN RD
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50310-1119
Mailing Address - Country:US
Mailing Address - Phone:515-274-4001
Mailing Address - Fax:515-274-5471
Practice Address - Street 1:5625 HICKMAN RD
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50310-1119
Practice Address - Country:US
Practice Address - Phone:515-274-4001
Practice Address - Fax:515-274-5471
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-02
Last Update Date:2009-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA89333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA98985OtherWELLMARK IOWA
IA1601740OtherNABP
IA0043877Medicaid
IA1194893537Medicaid
IA0043877Medicaid