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General NPI Number Information
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NPI Number | 1376110486
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Entity Type | Individual
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Provider Name | KENNETH JAQUEZ RICHARDSON PHARMD
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Gender | Male
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Dates
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Enumeration Date | 06/07/2021
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Last Update Date | 12/03/2025
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Provider Practice Location Address
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Address Line | 200 HAWTHORNE LN
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City | CHARLOTTE
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State | NC
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Zip | 28204-2515
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Country | US
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Telephone | 980-488-5336
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Fax | 704-316-2270
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Provider Business Mailing Address
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Address Line | 2010 N BREVARD ST APT 635
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City | CHARLOTTE
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State | NC
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Zip | 28206-3948
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Country | US
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Telephone | 706-951-4813
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Fax | 704-316-2270
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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 | 1835P2201X
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Taxonomy Name | Ambulatory Care Pharmacist
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License Number | 34259
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 1835P0018X
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Taxonomy Name | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
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License Number | 700651
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License Number State | NC
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