Provider Demographics
NPI:1922088665
Name:RIEBER, MICHAEL LEE (RPH)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:LEE
Last Name:RIEBER
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 1:1317 SILOAM AVE
Mailing Address - Street 2:
Mailing Address - City:IOWA FALLS
Mailing Address - State:IA
Mailing Address - Zip Code:50126-1040
Mailing Address - Country:US
Mailing Address - Phone:641-648-6795
Mailing Address - Fax:
Practice Address - Street 1:520 TALBOTT ST
Practice Address - Street 2:SUITE 2
Practice Address - City:IOWA FALLS
Practice Address - State:IA
Practice Address - Zip Code:50126-2379
Practice Address - Country:US
Practice Address - Phone:641-648-3733
Practice Address - Fax:641-648-3076
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA14888183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0201129Medicaid
IA0201129Medicaid