Provider Demographics
NPI:1811415748
Name:RIDDER, RICHARD ALBERT (RPH)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:ALBERT
Last Name:RIDDER
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 1:20601 W MINNEZONA AVE
Mailing Address - Street 2:
Mailing Address - City:BUCKEYE
Mailing Address - State:AZ
Mailing Address - Zip Code:85396-6536
Mailing Address - Country:US
Mailing Address - Phone:816-304-3305
Mailing Address - Fax:
Practice Address - Street 1:23477 W YUMA RD
Practice Address - Street 2:
Practice Address - City:BUCKEYE
Practice Address - State:AZ
Practice Address - Zip Code:85326-3103
Practice Address - Country:US
Practice Address - Phone:623-337-9161
Practice Address - Fax:623-337-9164
Is Sole Proprietor?:No
Enumeration Date:2017-08-30
Last Update Date:2017-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS021891183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist