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General NPI Number Information
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NPI Number | 1497758981
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Entity Type | Organization
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Legal Business Name | RIDDLE PHARMACY LLC
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Dates
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Enumeration Date | 05/27/2005
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Last Update Date | 05/28/2008
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Provider Practice Location Address
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Address Line | 142 MAIN STREET
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City | RIDDLE
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State | OR
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Zip | 97469
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Country | US
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Telephone | 541-874-2406
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Fax | 541-874-3256
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Provider Business Mailing Address
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Address Line | PO BOX 826
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City | RIDDLE
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State | OR
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Zip | 97469-0826
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Country | US
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Telephone | 541-874-2406
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Fax | 541-874-3256
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Authorized Official
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Title or Position | PHARMACIST
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Name | BLAKE RICE
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Credential |
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Telephone | 541-874-2406
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | RP0000483CS
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License Number State | OR
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