Provider Demographics
NPI:1649501891
Name:REIFF, MICHAEL ALLEN
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:ALLEN
Last Name:REIFF
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 1:5695 DULUTH STREET
Mailing Address - Street 2:
Mailing Address - City:GOLDEN VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55422
Mailing Address - Country:US
Mailing Address - Phone:763-546-5336
Mailing Address - Fax:763-546-2903
Practice Address - Street 1:5695 DULUTH ST
Practice Address - Street 2:
Practice Address - City:GOLDEN VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55422-4054
Practice Address - Country:US
Practice Address - Phone:763-546-5336
Practice Address - Fax:763-546-2903
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-27
Last Update Date:2010-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN114764183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist