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General NPI Number Information
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NPI Number | 1851994610
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Entity Type | Individual
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Provider Name | DEJUANA RICHARD PHARMD
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Gender | Female
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Dates
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Enumeration Date | 11/16/2020
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Last Update Date | 11/16/2020
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Provider Practice Location Address
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Address Line | 1619 DELAWARE AVE
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City | MCCOMB
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State | MS
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Zip | 39648-3609
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Country | US
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Telephone | 601-684-8670
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Fax |
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Provider Business Mailing Address
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Address Line | 2076 ALBERTA DR
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City | MAGNOLIA
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State | MS
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Zip | 39652-4099
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Country | US
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Telephone |
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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 | E-15001
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License Number State | MS
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