Provider Demographics
NPI:1699831966
Name:DEEMS S RIDDLE III
Entity Type:Organization
Organization Name:DEEMS S RIDDLE III
Other - Org Name:RAPID RX
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER AND PIC
Authorized Official - Prefix:
Authorized Official - First Name:DEEMS
Authorized Official - Middle Name:
Authorized Official - Last Name:RIDDLE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:423-510-2788
Mailing Address - Street 1:4335 RINGGOLD RD
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37412-2740
Mailing Address - Country:US
Mailing Address - Phone:423-510-2788
Mailing Address - Fax:423-510-2789
Practice Address - Street 1:4335 RINGGOLD RD
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37412-2740
Practice Address - Country:US
Practice Address - Phone:423-510-2788
Practice Address - Fax:423-510-2789
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-29
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN00000043523336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1699831966Medicaid
2095159OtherPK
669416001Medicare PIN