Basic Information
| Provider Information | |||||||||
| NPI: | 1205965845 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NELSON | ||||||||
| FirstName: | RICHARD | ||||||||
| MiddleName: | LOREN | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | R PH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 172702 W BYRON RD | ||||||||
| Address2: | |||||||||
| City: | PROSSER | ||||||||
| State: | WA | ||||||||
| PostalCode: | 993508544 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5097863237 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2010 YAKIMA VALLEY HWY STE C1 | ||||||||
| Address2: | |||||||||
| City: | SUNNYSIDE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 989441289 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5098932711 | ||||||||
| FaxNumber: | 5098394768 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/02/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | PH00007504 | WA | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.