Active NPI
Bruce Jon Riendeau, RPH
- Pharmacist
- Wautoma, WI
National Provider Identifier
1821342627
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 13298-40
- Practice address
- N2585 Plaza Rd # 1409
Wautoma, WI 54982-7706 - Phone
- (920) 787-2090
- Fax
- (920) 787-4605
- NPI assigned
- Oct 31, 2012
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 13298-40 | WI | Primary |
Addresses
Primary practice location
N2585 Plaza Rd # 1409
Wautoma, WI 54982-7706
Mailing address
N2585 Plaza Rd # 1409
Wautoma, WI 54982-7706
Phone (920) 787-2090
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1811941586 | Medicaid | WI |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 13298-40 | WI | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1351641600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1351641600000",
"number": "1821342627",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "N2585 PLAZA RD # 1409",
"city": "WAUTOMA",
"state": "WI",
"postal_code": "549827706",
"telephone_number": "920-787-2090",
"fax_number": "920-787-4605"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "N2585 PLAZA RD # 1409",
"city": "WAUTOMA",
"state": "WI",
"postal_code": "549827706",
"telephone_number": "920-787-2090",
"fax_number": "920-787-4605"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RIENDEAU",
"first_name": "BRUCE",
"middle_name": "JON",
"name_prefix": "Mr.",
"credential": "RPH",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2012-10-31",
"last_updated": "2012-10-31",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "WI",
"license": "13298-40",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1811941586",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Wautoma, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.