MEDICARE: MRS. STEPHANIE RICHMOND PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	5302029482	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5302029482	OTHER	MI	PHARMACIST

General Provider Information

NPI Number	:	1033290002
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. STEPHANIE RICHMOND PHARMD

Provider Business Mailing Address
First Line	:	210 HINCKLEY BLVD
Second Line	:
City	:	JACKSON
State	:	MI
Zip	:	49203-5313
Country	:	US
Telephone Number	:	517-784-3184
Fax Number	:

Provider Business Practice Location Address
First Line	:	210 HINCKLEY BLVD
Second Line	:
City	:	JACKSON
State	:	MI
Zip	:	49203-5313
Country	:	US
Telephone Number	:	517-784-3184
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/18/2006
Last Update Date	:	07/08/2007

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