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General NPI Number Information
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NPI Number | 1104470152
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Entity Type | Individual
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Provider Name | SHAWNA KRISTYNE RICHMOND PHARMD
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Gender | Female
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Dates
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Enumeration Date | 07/29/2019
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Last Update Date | 11/20/2024
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Provider Practice Location Address
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Address Line | 159 BEAVER PLZ
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City | BEAVER
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State | WV
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Zip | 25813-8400
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Country | US
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Telephone | 304-255-6630
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Fax |
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Provider Business Mailing Address
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Address Line | 266 OLD CLINE RD
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City | GHENT
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State | WV
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Zip | 25843-9348
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Country | US
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Telephone | 304-237-4431
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | RP0011137
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License Number State | WV
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