MEDICARE: MISS SIERRA S RICHARDSON CPHT

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	183700000X	Pharmacy Technician	284115	TX

General Provider Information

NPI Number	:	1053902353
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS SIERRA S RICHARDSON CPHT

Provider Business Mailing Address
First Line	:	6555 STATE HIGHWAY 161 STE B
Second Line	:
City	:	IRVING
State	:	TX
Zip	:	75039-2402
Country	:	US
Telephone Number	:	972-446-4154
Fax Number	:

Provider Business Practice Location Address
First Line	:	6555 STATE HIGHWAY 161 STE B
Second Line	:
City	:	IRVING
State	:	TX
Zip	:	75039-2402
Country	:	US
Telephone Number	:	972-446-4154
Fax Number	:

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

Provider Enumeration Date	:	01/29/2021
Last Update Date	:	09/30/2021

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