Provider Demographics
NPI:1376860858
Name:RIDILLA, KAREN P (RPH)
Entity Type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:P
Last Name:RIDILLA
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:840 WELDON ST
Mailing Address - Street 2:
Mailing Address - City:LATROBE
Mailing Address - State:PA
Mailing Address - Zip Code:15650-1609
Mailing Address - Country:US
Mailing Address - Phone:724-539-2541
Mailing Address - Fax:
Practice Address - Street 1:222 Y ST
Practice Address - Street 2:
Practice Address - City:DERRY
Practice Address - State:PA
Practice Address - Zip Code:15627-1259
Practice Address - Country:US
Practice Address - Phone:724-694-9811
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-23
Last Update Date:2010-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP028603L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist