Provider Demographics
NPI:1568980381
Name:RIEDL, CAROLYN (PHARMD)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:
Last Name:RIEDL
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 1:4718 SHELDON ST # A
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19127-1009
Mailing Address - Country:US
Mailing Address - Phone:920-428-7672
Mailing Address - Fax:
Practice Address - Street 1:2803 W MAIN ST
Practice Address - Street 2:
Practice Address - City:NORRISTOWN
Practice Address - State:PA
Practice Address - Zip Code:19403-1576
Practice Address - Country:US
Practice Address - Phone:484-636-5003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-31
Last Update Date:2017-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP451873183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist