Healthcare Provider Details

I. General information

NPI: 1912142795
Provider Name (Legal Business Name): RICHARD KENNETH PLOUDE JR. RPH.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2008
Last Update Date: 12/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 LOCKE DR SUITE C
MARLBOROUGH MA
01752-7230
US

IV. Provider business mailing address

140 LOCKE DR SUITE C
MARLBOROUGH MA
01752-7230
US

V. Phone/Fax

Practice location:
  • Phone: 508-573-5200
  • Fax: 508-490-8560
Mailing address:
  • Phone: 508-573-5200
  • Fax: 508-490-8560

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number22487
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: