MEDICARE: LOUIS JOSEPH RIEL PHARMD

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	11940	AZ

General Provider Information

NPI Number	:	1902808157
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LOUIS JOSEPH RIEL PHARMD

Provider Business Mailing Address
First Line	:	PO BOX 711812
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84171-1812
Country	:	US
Telephone Number	:	801-339-2812
Fax Number	:

Provider Business Practice Location Address
First Line	:	500 FOOTHILL DR
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84148-0001
Country	:	US
Telephone Number	:	801-582-1565
Fax Number	:

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

Provider Enumeration Date	:	06/01/2005
Last Update Date	:	07/08/2007

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