Provider Demographics
NPI:1316522436
Name:COUILLARD, RICHARD N JR (RPH)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:N
Last Name:COUILLARD
Suffix:JR
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 1:250 WHITING FARMS RD
Mailing Address - Street 2:
Mailing Address - City:HOLYOKE
Mailing Address - State:MA
Mailing Address - Zip Code:01040-2837
Mailing Address - Country:US
Mailing Address - Phone:413-532-3216
Mailing Address - Fax:
Practice Address - Street 1:250 WHITING FARMS RD
Practice Address - Street 2:
Practice Address - City:HOLYOKE
Practice Address - State:MA
Practice Address - Zip Code:01040-2837
Practice Address - Country:US
Practice Address - Phone:413-532-3216
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-10
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPR4045183500000X
MAPH235521183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist