Provider Demographics
NPI:1649329343
Name:RIDDLE, DEEMS (RPH)
Entity type:Individual
Prefix:
First Name:DEEMS
Middle Name:
Last Name:RIDDLE
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 1:1733 S SEMINOLE DR
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37412-1145
Mailing Address - Country:US
Mailing Address - Phone:423-510-2788
Mailing Address - Fax:423-510-2789
Practice Address - Street 1:4335 RINGGOLD RD
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37412-2740
Practice Address - Country:US
Practice Address - Phone:423-510-2788
Practice Address - Fax:423-510-2789
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3823183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist