Provider Demographics
NPI:1104362540
Name:RIEZENMAN, ADAM SETH (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:ADAM
Middle Name:SETH
Last Name:RIEZENMAN
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1095 W US HIGHWAY 77
Mailing Address - Street 2:
Mailing Address - City:SAN BENITO
Mailing Address - State:TX
Mailing Address - Zip Code:78586-4395
Mailing Address - Country:US
Mailing Address - Phone:956-399-5233
Mailing Address - Fax:
Practice Address - Street 1:1095 W US HIGHWAY 77
Practice Address - Street 2:
Practice Address - City:SAN BENITO
Practice Address - State:TX
Practice Address - Zip Code:78586-4395
Practice Address - Country:US
Practice Address - Phone:956-399-5233
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-09
Last Update Date:2017-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX59288183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist