Provider Demographics
NPI:1740592153
Name:RIEDEL, DONNA M
Entity Type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:M
Last Name:RIEDEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:169 VISTA DR
Mailing Address - Street 2:
Mailing Address - City:CANONSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15317-9572
Mailing Address - Country:US
Mailing Address - Phone:724-873-4648
Mailing Address - Fax:
Practice Address - Street 1:200 CRAFTON INGRAM SHP CTR
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15205-2353
Practice Address - Country:US
Practice Address - Phone:412-921-5755
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-14
Last Update Date:2010-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP037637L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist