Provider Demographics
NPI:1568684421
Name:RIEGEL, ROBERT JOHN (RPH)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:JOHN
Last Name:RIEGEL
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8726 PHEASANT RUN ROAD
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125
Mailing Address - Country:US
Mailing Address - Phone:651-730-8149
Mailing Address - Fax:
Practice Address - Street 1:ST PAUL CORNER DRUG
Practice Address - Street 2:240 S SNELLING AVE
Practice Address - City:ST PAUL
Practice Address - State:MN
Practice Address - Zip Code:55105
Practice Address - Country:US
Practice Address - Phone:651-698-8859
Practice Address - Fax:651-698-0005
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN115060183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN115060OtherMN BOARD OR RX ID#