Provider Demographics
NPI:1487142048
Name:RIDDLE, DAVID CHARLES (PHARMACIST)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:CHARLES
Last Name:RIDDLE
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1924 NEWFIELDS RD
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38139-4470
Mailing Address - Country:US
Mailing Address - Phone:901-753-5361
Mailing Address - Fax:
Practice Address - Street 1:8400 HWY 64
Practice Address - Street 2:
Practice Address - City:BARTLETT
Practice Address - State:TN
Practice Address - Zip Code:38133
Practice Address - Country:US
Practice Address - Phone:901-682-6106
Practice Address - Fax:901-371-2159
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-28
Last Update Date:2018-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN7531183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist