Provider Demographics
NPI:1013646777
Name:RIEGEL, LUCIE J
Entity Type:Individual
Prefix:
First Name:LUCIE
Middle Name:J
Last Name:RIEGEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:608 PROSPECT RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT AIRY
Mailing Address - State:MD
Mailing Address - Zip Code:21771-5607
Mailing Address - Country:US
Mailing Address - Phone:240-418-6974
Mailing Address - Fax:
Practice Address - Street 1:1001 TWIN ARCH RD
Practice Address - Street 2:
Practice Address - City:MOUNT AIRY
Practice Address - State:MD
Practice Address - Zip Code:21771-4138
Practice Address - Country:US
Practice Address - Phone:301-829-1149
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-08
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDT26236183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician