Provider Demographics
NPI:1003412362
Name:RILEY, THOMAS CLARK (RPH)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:CLARK
Last Name:RILEY
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:LEBANON SHOPS PHARMACY
Mailing Address - Street 2:300 MT LEBANON BLVD
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15234
Mailing Address - Country:US
Mailing Address - Phone:412-670-9781
Mailing Address - Fax:412-344-5223
Practice Address - Street 1:LEBANON SHOPS PHARMACY
Practice Address - Street 2:300 MT LEBANON BLVD
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15234
Practice Address - Country:US
Practice Address - Phone:412-670-9781
Practice Address - Fax:412-344-5223
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-10
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP031918L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist