Provider Demographics
NPI:1396302931
Name:RIETH, ALEXANDER MICHAEL
Entity type:Individual
Prefix:DR
First Name:ALEXANDER
Middle Name:MICHAEL
Last Name:RIETH
Suffix:
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 1:9443 BEAR SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:BREWERTON
Mailing Address - State:NY
Mailing Address - Zip Code:13029-8721
Mailing Address - Country:US
Mailing Address - Phone:315-243-8494
Mailing Address - Fax:
Practice Address - Street 1:578 DICK RD
Practice Address - Street 2:
Practice Address - City:DEPEW
Practice Address - State:NY
Practice Address - Zip Code:14043-1846
Practice Address - Country:US
Practice Address - Phone:716-683-9870
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-20
Last Update Date:2022-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY065755183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program