Basic Information
| Provider Information | |||||||||
| NPI: | 1356401269 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | REIBER | ||||||||
| FirstName: | EILENE | ||||||||
| MiddleName: | |||||||||
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| Credential: | RPH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6835 WILDRIDGE RD | ||||||||
| Address2: | |||||||||
| City: | COLORADO SPRINGS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 809082817 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7194950206 | ||||||||
| FaxNumber: | 7194950206 | ||||||||
| Practice Location | |||||||||
| Address1: | 2270 GARDEN OF THE GODS RD | ||||||||
| Address2: | SUITE 102 | ||||||||
| City: | COLORADO SPRINGS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 809079438 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7195703100 | ||||||||
| FaxNumber: | 1795703125 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/11/2006 | ||||||||
| LastUpdateDate: | 03/21/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 12778 | CO | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.