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General NPI Number Information
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NPI Number | 1003591579
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Entity Type | Individual
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Provider Name | NATHAN RIEDEMAN PHARMD
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Gender | Male
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Dates
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Enumeration Date | 06/21/2023
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Last Update Date | 06/21/2023
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Provider Practice Location Address
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Address Line | 356 12TH ST SW
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City | FOREST LAKE
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State | MN
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Zip | 55025-1749
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Country | US
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Telephone | 651-464-1994
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Fax |
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Provider Business Mailing Address
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Address Line | 10130 JULEP TRL N
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City | SCANDIA
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State | MN
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Zip | 55073-9770
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Country | US
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Telephone | 651-500-5466
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 813773
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License Number State | MN
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