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General NPI Number Information
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NPI Number | 1699831966
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Entity Type | Organization
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Legal Business Name | DEEMS S RIDDLE III
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Dates
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Enumeration Date | 12/29/2006
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Last Update Date | 01/18/2017
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Provider Practice Location Address
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Address Line | 4335 RINGGOLD RD
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City | CHATTANOOGA
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State | TN
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Zip | 37412-2740
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Country | US
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Telephone | 423-510-2788
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Fax | 423-510-2789
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Provider Business Mailing Address
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Address Line | 4335 RINGGOLD RD
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City | CHATTANOOGA
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State | TN
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Zip | 37412-2740
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Country | US
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Telephone | 423-510-2788
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Fax | 423-510-2789
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Authorized Official
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Title or Position | OWNER AND PIC
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Name | DEEMS RIDDLE
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Credential | RPH
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Telephone | 423-510-2788
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 0000004352
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License Number State | TN
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