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General NPI Number Information
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NPI Number | 1407469281
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Entity Type | Individual
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Provider Name | THERON RICHARDSON
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Gender | Male
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Dates
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Enumeration Date | 08/31/2020
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Last Update Date | 08/31/2020
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Provider Practice Location Address
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Address Line | 1241 BLAKESLEE BOULEVARD DR E STE 2
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City | LEHIGHTON
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State | PA
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Zip | 18235-2401
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Country | US
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Telephone | 570-386-5838
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Fax |
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Provider Business Mailing Address
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Address Line | 701 HARRISON ST APT 111
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City | ALLENTOWN
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State | PA
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Zip | 18103-3043
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Country | US
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Telephone | 347-817-9594
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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 | RP454775
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License Number State | PA
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