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General NPI Number Information
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NPI Number | 1114503331
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Entity Type | Individual
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Provider Name | MR. RYAN RIEVES
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Gender | Male
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Dates
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Enumeration Date | 03/18/2021
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Last Update Date | 03/18/2021
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Provider Practice Location Address
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Address Line | 5110 TIMES SQUARE PL
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City | OKEMOS
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State | MI
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Zip | 48864-1161
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Country | US
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Telephone | 517-381-8267
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Fax |
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Provider Business Mailing Address
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Address Line | 1480 W ALWARD RD
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City | DEWITT
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State | MI
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Zip | 48820-9784
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Country | US
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Telephone | 517-243-8931
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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 | 183700000X
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Taxonomy Name | Pharmacy Technician
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License Number | 5303008397
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License Number State | MI
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