Provider Demographics
NPI:1104428739
Name:RIEDEL, ROBERT JEFFREY
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:JEFFREY
Last Name:RIEDEL
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 1:8223 ELLIOTT RD
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:MD
Mailing Address - Zip Code:21601-2956
Mailing Address - Country:US
Mailing Address - Phone:410-819-3218
Mailing Address - Fax:410-819-6890
Practice Address - Street 1:8223 ELLIOTT RD
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:MD
Practice Address - Zip Code:21601-2956
Practice Address - Country:US
Practice Address - Phone:410-819-3218
Practice Address - Fax:410-819-6890
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-09
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD14293183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist