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General NPI Number Information
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NPI Number | 1326023664
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Entity Type | Organization
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Legal Business Name | KRIDERS INC
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Dates
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Enumeration Date | 12/09/2005
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 1119 W MASON ST
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City | GREEN BAY
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State | WI
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Zip | 54303-1895
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Country | US
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Telephone | 920-499-6225
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Fax | 920-499-4544
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Provider Business Mailing Address
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Address Line | 1119 W MASON ST
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City | GREEN BAY
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State | WI
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Zip | 54303-1895
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Country | US
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Telephone | 920-499-6225
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Fax | 920-499-4544
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Authorized Official
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Title or Position | OWNER
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Name | MR. GARY BRIAN KRIDER
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Credential | RPH
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Telephone | 920-499-6772
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State | WI
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