=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336251297
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RICHARD MEDICAL CLINIC INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/31/2006
-----------------------------------------------------
Last Update Date | 10/18/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 507 N MARKET ST
-----------------------------------------------------
City | OPELOUSAS
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70570-5279
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 337-942-1400
-----------------------------------------------------
Fax | 337-942-5595
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 507 N MARKET ST
-----------------------------------------------------
City | OPELOUSAS
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70570-5279
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 337-942-1400
-----------------------------------------------------
Fax | 337-942-5595
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DAWNIA WILLIS
-----------------------------------------------------
Credential | PHARMACIST
-----------------------------------------------------
Telephone | 337-942-1400
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | PHY002222IR
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------