Provider Demographics
NPI:1316439730
Name:RICHARDS, STEWART LYNN (RPH)
Entity type:Individual
Prefix:
First Name:STEWART
Middle Name:LYNN
Last Name:RICHARDS
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1539 NE STEPHENS ST
Mailing Address - Street 2:
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97470-1563
Mailing Address - Country:US
Mailing Address - Phone:541-957-2546
Mailing Address - Fax:541-957-2548
Practice Address - Street 1:1539 NE STEPHENS ST
Practice Address - Street 2:
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97470-1563
Practice Address - Country:US
Practice Address - Phone:541-957-2546
Practice Address - Fax:541-957-2548
Is Sole Proprietor?:No
Enumeration Date:2018-06-01
Last Update Date:2019-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH-0016584183500000X, 1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist