Provider Demographics
NPI:1720307820
Name:BISHOP, RICHARD ALFRED (PHARMACIST)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:ALFRED
Last Name:BISHOP
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:753 S GROVE ST
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48198-6304
Mailing Address - Country:US
Mailing Address - Phone:734-482-7430
Mailing Address - Fax:734-480-1353
Practice Address - Street 1:753 S GROVE ST
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48198-6304
Practice Address - Country:US
Practice Address - Phone:734-482-7430
Practice Address - Fax:734-480-1353
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-28
Last Update Date:2010-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302022973183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist