Healthcare Provider Details

I. General information

NPI: 1073784328
Provider Name (Legal Business Name): ROBERT FONTAINE RICHARDSON PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2008
Last Update Date: 03/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2724 CROUCHWOOD RD
LITTLE ROCK AR
72207-2744
US

IV. Provider business mailing address

2724 CROUCHWOOD RD
LITTLE ROCK AR
72207-2744
US

V. Phone/Fax

Practice location:
  • Phone: 501-663-5794
  • Fax:
Mailing address:
  • Phone: 501-663-5794
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License Number6881
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: