Provider Demographics
NPI:1285234781
Name:RIDENOUR, AMBER
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:RIDENOUR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16911 STATE ROUTE 501
Mailing Address - Street 2:
Mailing Address - City:WAPAKONETA
Mailing Address - State:OH
Mailing Address - Zip Code:45895-9332
Mailing Address - Country:US
Mailing Address - Phone:419-773-9132
Mailing Address - Fax:
Practice Address - Street 1:1257 BELLEFONTAINE ST
Practice Address - Street 2:
Practice Address - City:WAPAKONETA
Practice Address - State:OH
Practice Address - Zip Code:45895-9732
Practice Address - Country:US
Practice Address - Phone:419-738-0490
Practice Address - Fax:419-738-0493
Is Sole Proprietor?:No
Enumeration Date:2020-10-26
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-1-27149183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist