Healthcare Provider Details

I. General information

NPI: 1407146608
Provider Name (Legal Business Name): RICHARD LEE EMERY RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2011
Last Update Date: 04/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1626 E PERRY ST
PORT CLINTON OH
43452-1332
US

IV. Provider business mailing address

504 BERKSHIRE CT
HURON OH
44839-1487
US

V. Phone/Fax

Practice location:
  • Phone: 419-734-5583
  • Fax:
Mailing address:
  • Phone: 419-433-4420
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03215557
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: