Provider Demographics
NPI:1497758981
Name:RIDDLE PHARMACY LLC
Entity Type:Organization
Organization Name:RIDDLE PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:BLAKE
Authorized Official - Middle Name:
Authorized Official - Last Name:RICE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-874-2406
Mailing Address - Street 1:PO BOX 826
Mailing Address - Street 2:
Mailing Address - City:RIDDLE
Mailing Address - State:OR
Mailing Address - Zip Code:97469-0826
Mailing Address - Country:US
Mailing Address - Phone:541-874-2406
Mailing Address - Fax:541-874-3256
Practice Address - Street 1:142 MAIN STREET
Practice Address - Street 2:
Practice Address - City:RIDDLE
Practice Address - State:OR
Practice Address - Zip Code:97469
Practice Address - Country:US
Practice Address - Phone:541-874-2406
Practice Address - Fax:541-874-3256
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-27
Last Update Date:2008-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRP0000483CS333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR169490Medicaid
OR269347OtherMEDICAID DME
OR269347OtherMEDICAID DME
OR5318330001Medicare ID - Type Unspecified
OR169490Medicaid