Provider Demographics
NPI:1750347506
Name:FIDDIE, RICHARD GLENN (RPH)
Entity type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:GLENN
Last Name:FIDDIE
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 1:2120 EAST MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:DUNCAN
Mailing Address - State:SC
Mailing Address - Zip Code:29334
Mailing Address - Country:US
Mailing Address - Phone:864-517-2294
Mailing Address - Fax:
Practice Address - Street 1:230 ROPER MOUNTAIN ROAD EXT
Practice Address - Street 2:APT # 516E
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-4853
Practice Address - Country:US
Practice Address - Phone:864-517-2294
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-21
Last Update Date:2017-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6794183500000X
NC14718183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist