Healthcare Provider Details

I. General information

NPI: 1689647653
Provider Name (Legal Business Name): NORENE RIEDLE CPHT
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/09/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3795 KIESEL AVE
OGDEN UT
84405-1601
US

IV. Provider business mailing address

1133 W 1600 S
WOODS CROSS UT
84087-2204
US

V. Phone/Fax

Practice location:
  • Phone: 801-394-6414
  • Fax:
Mailing address:
  • Phone: 801-394-6414
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number336985-1717
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: