Healthcare Provider Details

I. General information

NPI: 1326392903
Provider Name (Legal Business Name): TIFFANY L RICHARD RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/03/2012
Last Update Date: 05/14/2021
Certification Date: 05/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1210 HIGHWAY 31
ARNAUDVILLE LA
70512-5404
US

IV. Provider business mailing address

213 SPANISH PASS RD
BOERNE TX
78006-7935
US

V. Phone/Fax

Practice location:
  • Phone: 337-288-7687
  • Fax:
Mailing address:
  • Phone: 337-288-7687
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number15766
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number51373
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: