Provider Demographics
NPI:1790647386
Name:RICHARDSON, ANAISSA ARIANA (PHARMD)
Entity type:Individual
Prefix:DR
First Name:ANAISSA
Middle Name:ARIANA
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:ANAISSA
Other - Middle Name:ARIANA
Other - Last Name:LEAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:1904 DARTMOUTH ST APT B1
Mailing Address - Street 2:
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77840-3980
Mailing Address - Country:US
Mailing Address - Phone:956-282-9655
Mailing Address - Fax:
Practice Address - Street 1:1904 DARTMOUTH ST APT B1
Practice Address - Street 2:
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77840-3980
Practice Address - Country:US
Practice Address - Phone:956-282-9655
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-12-02
Last Update Date:2025-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID8871985183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist