MEDICARE: BRETT RIDDLE PHARM-D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	43304	TX

General Provider Information

NPI Number	:	1356342471
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRETT RIDDLE PHARM-D

Provider Business Mailing Address
First Line	:	2915 N. CAMINO LAGOS
Second Line	:
City	:	GRAND PRAIRIE
State	:	TX
Zip	:	75054
Country	:	US
Telephone Number	:	817-453-7563
Fax Number	:

Provider Business Practice Location Address
First Line	:	301 SW PLAZA SHOPPING CENTER
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76016
Country	:	US
Telephone Number	:	817-478-4238
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/10/2005
Last Update Date	:	07/08/2007

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Directions to “ BRETT RIDDLE PHARM-D” Practice Location

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