Provider Demographics
NPI:1285093401
Name:RICHMOND, SILAS II (PHARMD)
Entity type:Individual
Prefix:
First Name:SILAS
Middle Name:
Last Name:RICHMOND
Suffix:II
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 W SOUTH ST
Mailing Address - Street 2:UNIT 11
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39203-3606
Mailing Address - Country:US
Mailing Address - Phone:601-624-3366
Mailing Address - Fax:
Practice Address - Street 1:300 W SOUTH ST
Practice Address - Street 2:UNIT 11
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39203-3606
Practice Address - Country:US
Practice Address - Phone:601-624-3366
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-16
Last Update Date:2016-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS12697183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist