Provider Demographics
NPI:1114166071
Name:RILEY, KEVIN R (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:R
Last Name:RILEY
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 GREAT OAKS TRL
Mailing Address - Street 2:
Mailing Address - City:WADSWORTH
Mailing Address - State:OH
Mailing Address - Zip Code:44281-8712
Mailing Address - Country:US
Mailing Address - Phone:330-336-6488
Mailing Address - Fax:330-336-5479
Practice Address - Street 1:175 GREAT OAKS TRL
Practice Address - Street 2:
Practice Address - City:WADSWORTH
Practice Address - State:OH
Practice Address - Zip Code:44281-8712
Practice Address - Country:US
Practice Address - Phone:330-336-6488
Practice Address - Fax:330-336-5479
Is Sole Proprietor?:No
Enumeration Date:2009-02-16
Last Update Date:2009-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOH - 03228311183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist