Provider Demographics
NPI:1760823504
Name:RIDDLE, DANIEL (PD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:RIDDLE
Suffix:
Gender:M
Credentials:PD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9200 N RODNEY PARHAM RD
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72227-6202
Mailing Address - Country:US
Mailing Address - Phone:501-223-9814
Mailing Address - Fax:501-223-8572
Practice Address - Street 1:9200 N RODNEY PARHAM RD
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72227-6202
Practice Address - Country:US
Practice Address - Phone:501-223-9814
Practice Address - Fax:501-223-8572
Is Sole Proprietor?:No
Enumeration Date:2013-07-09
Last Update Date:2013-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD07253183500000X
TN7486183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist