Provider Demographics
NPI:1083027908
Name:RIET AID
Entity Type:Organization
Organization Name:RIET AID
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:BRION
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:517-745-8026
Mailing Address - Street 1:2255 S JACKSON RD
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49201-8344
Mailing Address - Country:US
Mailing Address - Phone:517-780-9536
Mailing Address - Fax:517-782-9140
Practice Address - Street 1:2255 S JACKSON RD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49201
Practice Address - Country:US
Practice Address - Phone:517-780-9536
Practice Address - Fax:517-782-9140
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-09
Last Update Date:2014-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302023467183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5302023467OtherPHARMACY