Provider Demographics
NPI:1356342471
Name:RIDDLE, BRETT (PHARM-D)
Entity type:Individual
Prefix:
First Name:BRETT
Middle Name:
Last Name:RIDDLE
Suffix:
Gender:M
Credentials:PHARM-D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2915 N. CAMINO LAGOS
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75054
Mailing Address - Country:US
Mailing Address - Phone:817-453-7563
Mailing Address - Fax:
Practice Address - Street 1:301 SW PLAZA SHOPPING CENTER
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76016
Practice Address - Country:US
Practice Address - Phone:817-478-4238
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX43304183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist