Healthcare Provider Details

I. General information

NPI: 1821522525
Provider Name (Legal Business Name): LAURA RIDDLE PHARM.D., RPH.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/19/2017
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1240 PARK AVE W
MANSFIELD OH
44906-2814
US

IV. Provider business mailing address

1240 PARK AVE W
MANSFIELD OH
44906-2814
US

V. Phone/Fax

Practice location:
  • Phone: 419-528-1862
  • Fax: 419-528-1864
Mailing address:
  • Phone: 419-528-1862
  • Fax: 419-528-1864

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number03330926
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: