Provider Demographics
NPI:1427220391
Name:RIDER-BECKER, JOAN MARIE (PHARMD/CDE)
Entity Type:Individual
Prefix:DR
First Name:JOAN
Middle Name:MARIE
Last Name:RIDER-BECKER
Suffix:
Gender:F
Credentials:PHARMD/CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2643 LENWOOD LN NE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49525-3980
Mailing Address - Country:US
Mailing Address - Phone:616-363-3222
Mailing Address - Fax:
Practice Address - Street 1:6745 FULTON ST E
Practice Address - Street 2:
Practice Address - City:ADA
Practice Address - State:MI
Practice Address - Zip Code:49301-8107
Practice Address - Country:US
Practice Address - Phone:616-682-9100
Practice Address - Fax:616-682-9400
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-31
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53024109021835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy