Doctor Name: | DAG RIVEDAL |
NPI Number: | 1154694610 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | RPH |
License Number: | 1176940 |
Business Practice Address: | 3201 E Layton Ave Cudahy, WI - 531101402 |
Business Phone Number: | 4144818220 |
Business Fax Number: | |
Mailing Address: | 8509 W Cascade Oaks Ct, FRANKLIN |
State: | WI |
Postal Code: | 531328530 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 02/14/2012 |
NPI Last Update Date: | 02/14/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1835P0018X |
License Number: | 1176940 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WI |
Taxonomy Type: | Pharmacy Service Providers |
Taxonomy Classification: | Pharmacist |
Taxonomy Specialization: | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist |
Taxonomy Definition: | Pharmacist Clinician/Clinical Pharmacy Specialist is a pharmacist with additional training and an expanded scope of practice that may include prescriptive authority, therapeutic management, and disease management. |