Healthcare Provider Details

I. General information

NPI: 1538772108
Provider Name (Legal Business Name): ANTHONY EARL RICHARDSON CPHT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2020
Last Update Date: 08/25/2020
Certification Date: 08/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

490 W WASHINGTON ST
SEQUIM WA
98382-3342
US

IV. Provider business mailing address

PO BOX 333
CARLSBORG WA
98324-0333
US

V. Phone/Fax

Practice location:
  • Phone: 360-681-2018
  • Fax: 360-681-7059
Mailing address:
  • Phone: 606-812-0183
  • Fax: 360-681-7059

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License NumberVA60879040
License Number StateWA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: