Provider Demographics
NPI:1255849782
Name:RIEBEN, MICHAEL CARL
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:CARL
Last Name:RIEBEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2151 WINTHORNE LN
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37129-6630
Mailing Address - Country:US
Mailing Address - Phone:615-260-0160
Mailing Address - Fax:
Practice Address - Street 1:2000 OLD FORT PKWY
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37129-6907
Practice Address - Country:US
Practice Address - Phone:615-895-3164
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-18
Last Update Date:2018-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4722183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist