Provider Demographics
NPI:1306440987
Name:TRIEBES, RICHARD CLINTON (RPH)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:CLINTON
Last Name:TRIEBES
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 1:115 E MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:NEW LENOX
Mailing Address - State:IL
Mailing Address - Zip Code:60451-1833
Mailing Address - Country:US
Mailing Address - Phone:815-215-3183
Mailing Address - Fax:
Practice Address - Street 1:115 E MAPLE ST
Practice Address - Street 2:
Practice Address - City:NEW LENOX
Practice Address - State:IL
Practice Address - Zip Code:60451-1833
Practice Address - Country:US
Practice Address - Phone:815-215-3183
Practice Address - Fax:815-768-1772
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-24
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051036059183500000X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No183500000XPharmacy Service ProvidersPharmacist