=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457363558
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARY B. RIEGLE RPH
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/13/2006
-----------------------------------------------------
Last Update Date | 07/09/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 421 GEORGESVILLE RD
-----------------------------------------------------
City | COLUMBUS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43228-2420
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 614-279-9368
-----------------------------------------------------
Fax | 614-792-0483
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4600 ARROWHEAD RD
-----------------------------------------------------
City | POWELL
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43065-8949
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 614-792-3368
-----------------------------------------------------
Fax | 614-792-0483
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 03-1-13499
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------