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NPI Code Detail

MEDICARE: MR. ZACHARY E RICHMOND CT, LCDC III

MEDICARE: MR. ZACHARY E RICHMOND CT, LCDC III
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
1390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1336650696
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. ZACHARY E RICHMOND CT, LCDC III
Provider Business Mailing Address
First Line : 815 S SOUTH ST
Second Line :
City : WILMINGTON
State : OH
Zip : 45177-2755
Country : US
Telephone Number : 855-553-9355
Fax Number :
Provider Business Practice Location Address
First Line : 815 S SOUTH ST
Second Line :
City : WILMINGTON
State : OH
Zip : 45177-2755
Country : US
Telephone Number : 855-553-9355
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/13/2017
Last Update Date : 10/13/2017

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