Provider Demographics
NPI:1407167141
Name:RIETZ, STEVEN K (PHARMD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:K
Last Name:RIETZ
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9
Mailing Address - Street 2:1HOSPITAL ROAD
Mailing Address - City:CROW AGENCY
Mailing Address - State:MT
Mailing Address - Zip Code:59022-0009
Mailing Address - Country:US
Mailing Address - Phone:406-638-3578
Mailing Address - Fax:406-638-3326
Practice Address - Street 1:1 HOSPITAL ROAD
Practice Address - Street 2:USPHS INDIAN HOSPITAL PHARMACY
Practice Address - City:CROW AGENCY
Practice Address - State:MT
Practice Address - Zip Code:59022-0009
Practice Address - Country:US
Practice Address - Phone:406-638-3353
Practice Address - Fax:406-638-3326
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-28
Last Update Date:2016-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA164941835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD304005586OtherBOARD CERTIFIED PHARMACOTHERAPY SPECIALIST