Provider Demographics
NPI:1053902353
Name:RICHARDSON, SIERRA S (CPHT)
Entity type:Individual
Prefix:MISS
First Name:SIERRA
Middle Name:S
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6555 STATE HIGHWAY 161 STE B
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75039-2402
Mailing Address - Country:US
Mailing Address - Phone:972-446-4154
Mailing Address - Fax:
Practice Address - Street 1:6555 STATE HIGHWAY 161 STE B
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75039-2402
Practice Address - Country:US
Practice Address - Phone:972-446-4154
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-29
Last Update Date:2021-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX284115183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician