MEDICARE: MR. ROBERT RIFFERT RPH

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	183500000X	Pharmacist	5302024892	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2351485	OTHER	MI	NCPDP
2	1497844047	OTHER	MI	NPI
3	540B603020	OTHER	MI	BCBS MICHIGAN DME
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1114001781
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ROBERT RIFFERT RPH

Provider Business Mailing Address
First Line	:	PO BOX 575
Second Line	:
City	:	BEAVERTON
State	:	MI
Zip	:	48612-0575
Country	:	US
Telephone Number	:	989-435-7778
Fax Number	:	989-435-2581

Provider Business Practice Location Address
First Line	:	127 W BROWN ST
Second Line	:	PO 575
City	:	BEAVERTON
State	:	MI
Zip	:	48612-8119
Country	:	US
Telephone Number	:	989-435-7778
Fax Number	:	989-435-2581

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

Provider Enumeration Date	:	10/24/2006
Last Update Date	:	02/02/2021

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