Provider Demographics
NPI:1023365426
Name:RIVLIN, ALLEN L (RPH)
Entity Type:Individual
Prefix:MR
First Name:ALLEN
Middle Name:L
Last Name:RIVLIN
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 1:10000 PARK CEDAR DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-8902
Mailing Address - Country:US
Mailing Address - Phone:704-541-5355
Mailing Address - Fax:
Practice Address - Street 1:10000 PARK CEDAR DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-8902
Practice Address - Country:US
Practice Address - Phone:704-541-5355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-06
Last Update Date:2012-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC17004183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist