Provider Demographics
NPI:1659679918
Name:RIEGELHAUPT, MARK ALAN (RPH)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:ALAN
Last Name:RIEGELHAUPT
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 1:1372 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FUQUAY VARINA
Mailing Address - State:NC
Mailing Address - Zip Code:27526-2617
Mailing Address - Country:US
Mailing Address - Phone:919-557-5473
Mailing Address - Fax:919-557-6842
Practice Address - Street 1:1372 N MAIN ST
Practice Address - Street 2:
Practice Address - City:FUQUAY VARINA
Practice Address - State:NC
Practice Address - Zip Code:27526-2617
Practice Address - Country:US
Practice Address - Phone:919-557-5473
Practice Address - Fax:919-557-6842
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-09
Last Update Date:2011-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12514183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist