Provider Demographics
NPI:1134456775
Name:RILEY, MARCUS COBEY (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MARCUS
Middle Name:COBEY
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 1:3905 CONCORD PKWY S
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28027-9058
Mailing Address - Country:US
Mailing Address - Phone:704-292-3291
Mailing Address - Fax:
Practice Address - Street 1:3905 CONCORD PKWY S
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28027-9058
Practice Address - Country:US
Practice Address - Phone:704-292-3291
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-03
Last Update Date:2016-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC19040183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC19040OtherNORTH CAROLINA BOARD OF PHARMACY