Provider Demographics
NPI:1255852828
Name:RIEMER, CARLI
Entity Type:Individual
Prefix:
First Name:CARLI
Middle Name:
Last Name:RIEMER
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 1:100 CRESTVIEW CIR STE 120
Mailing Address - Street 2:
Mailing Address - City:LOUISBURG
Mailing Address - State:KS
Mailing Address - Zip Code:66053-6472
Mailing Address - Country:US
Mailing Address - Phone:913-837-3784
Mailing Address - Fax:
Practice Address - Street 1:100 CRESTVIEW CIR STE 120
Practice Address - Street 2:
Practice Address - City:LOUISBURG
Practice Address - State:KS
Practice Address - Zip Code:66053-6472
Practice Address - Country:US
Practice Address - Phone:913-837-3784
Practice Address - Fax:913-837-3784
Is Sole Proprietor?:No
Enumeration Date:2017-07-04
Last Update Date:2017-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-103024183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist