Provider Demographics
NPI:1801171467
Name:RIEGELHAUPT, LINDA BETH (RPH)
Entity type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:BETH
Last Name:RIEGELHAUPT
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1630 MCCRAREN RD
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60035-2223
Mailing Address - Country:US
Mailing Address - Phone:847-831-3314
Mailing Address - Fax:847-831-3356
Practice Address - Street 1:2501 WAUKEGAN RD
Practice Address - Street 2:
Practice Address - City:BANNOCKBURN
Practice Address - State:IL
Practice Address - Zip Code:60015-1569
Practice Address - Country:US
Practice Address - Phone:847-940-8104
Practice Address - Fax:847-940-1532
Is Sole Proprietor?:No
Enumeration Date:2011-10-14
Last Update Date:2011-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051028846183500000X
FLPS0013332183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist