Healthcare Provider Details

I. General information

NPI: 1336251297
Provider Name (Legal Business Name): RICHARD MEDICAL CLINIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 10/18/2022
Certification Date: 10/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

507 N MARKET ST
OPELOUSAS LA
70570-5279
US

IV. Provider business mailing address

507 N MARKET ST
OPELOUSAS LA
70570-5279
US

V. Phone/Fax

Practice location:
  • Phone: 337-942-1400
  • Fax: 337-942-5595
Mailing address:
  • Phone: 337-942-1400
  • Fax: 337-942-5595

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHY002222IR
License Number StateLA

VIII. Authorized Official

Name: DAWNIA WILLIS
Title or Position: OWNER
Credential: PHARMACIST
Phone: 337-942-1400