Provider Demographics
NPI:1821989773
Name:RIDDELL, DAVID III
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:RIDDELL
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:855 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:TN
Mailing Address - Zip Code:38372-1163
Mailing Address - Country:US
Mailing Address - Phone:731-926-0337
Mailing Address - Fax:
Practice Address - Street 1:775 PICKWICK ST
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:TN
Practice Address - Zip Code:38372-3053
Practice Address - Country:US
Practice Address - Phone:731-925-6200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-10
Last Update Date:2025-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN49100183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist