Provider Demographics
NPI:1508997842
Name:RIETH, CANDACE (PHARMD)
Entity Type:Individual
Prefix:
First Name:CANDACE
Middle Name:
Last Name:RIETH
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4215 BAY HILL DR
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72034-8195
Mailing Address - Country:US
Mailing Address - Phone:501-336-8811
Mailing Address - Fax:
Practice Address - Street 1:4215 BAY HILL DR
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72034-8195
Practice Address - Country:US
Practice Address - Phone:501-336-8811
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD08177183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist