Provider Demographics
NPI:1881965168
Name:RIDDELL, VIRGINIA E (RPH)
Entity type:Individual
Prefix:MRS
First Name:VIRGINIA
Middle Name:E
Last Name:RIDDELL
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 1:101 N TENNESSE STREET
Mailing Address - Street 2:
Mailing Address - City:CARTERSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30120-2303
Mailing Address - Country:US
Mailing Address - Phone:770-387-2525
Mailing Address - Fax:
Practice Address - Street 1:101 N TENNESSE STREET
Practice Address - Street 2:
Practice Address - City:CARTERSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30120-2303
Practice Address - Country:US
Practice Address - Phone:770-387-2525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-19
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS38041183500000X
NY040309183500000X
GARPH027031183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist