Provider Demographics
NPI:1033973623
Name:ALWAISI, RIYAD (RPH)
Entity Type:Individual
Prefix:
First Name:RIYAD
Middle Name:
Last Name:ALWAISI
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 1:1306 MICHAEL CIR
Mailing Address - Street 2:
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38801-6111
Mailing Address - Country:US
Mailing Address - Phone:313-642-3728
Mailing Address - Fax:
Practice Address - Street 1:1306 MICHAEL CIR
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38801-6111
Practice Address - Country:US
Practice Address - Phone:313-642-3728
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-13
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE-101334183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist