Provider Demographics
NPI:1235374646
Name:RILEY, TREAVOR T (PHARMD,BCPS)
Entity Type:Individual
Prefix:DR
First Name:TREAVOR
Middle Name:T
Last Name:RILEY
Suffix:
Gender:M
Credentials:PHARMD,BCPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3849 NORTH BLVD
Mailing Address - Street 2:ULM COLLEGE OF PHARMACY
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-3854
Mailing Address - Country:US
Mailing Address - Phone:225-346-5957
Mailing Address - Fax:225-219-9813
Practice Address - Street 1:3600 FLORIDA BLVD
Practice Address - Street 2:DEPARTMENT OF PHARMACY
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-3842
Practice Address - Country:US
Practice Address - Phone:225-346-5957
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-14
Last Update Date:2008-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA0184241835P0018X, 1835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist