Provider Demographics
NPI:1366729071
Name:RICHARDSON, MICHAEL GERARD I (RPH)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:GERARD
Last Name:RICHARDSON
Suffix:I
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 1:420 N FRAZIER ST
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77301-2882
Mailing Address - Country:US
Mailing Address - Phone:936-494-0424
Mailing Address - Fax:936-494-0431
Practice Address - Street 1:420 N FRAZIER ST
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77301-2882
Practice Address - Country:US
Practice Address - Phone:936-494-0424
Practice Address - Fax:936-494-0431
Is Sole Proprietor?:No
Enumeration Date:2011-11-09
Last Update Date:2011-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX36336183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist