Provider Demographics
NPI:1023654332
Name:RICHARDSON, TANYA (RPH)
Entity type:Individual
Prefix:
First Name:TANYA
Middle Name:
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9302 HADWAY DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46256-1027
Mailing Address - Country:US
Mailing Address - Phone:317-339-4151
Mailing Address - Fax:
Practice Address - Street 1:1601 E MICHIGAN RD
Practice Address - Street 2:
Practice Address - City:SHELBYVILLE
Practice Address - State:IN
Practice Address - Zip Code:46176-4058
Practice Address - Country:US
Practice Address - Phone:317-421-2356
Practice Address - Fax:317-421-2357
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-21
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26019946A1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist