Provider Demographics
NPI:1285661553
Name:RILEY DRUGS INC
Entity Type:Organization
Organization Name:RILEY DRUGS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORP PRES
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:D
Authorized Official - Last Name:RILEY
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:630-232-0650
Mailing Address - Street 1:415 W STATE ST
Mailing Address - Street 2:
Mailing Address - City:GENEVA
Mailing Address - State:IL
Mailing Address - Zip Code:60134-2157
Mailing Address - Country:US
Mailing Address - Phone:630-232-0650
Mailing Address - Fax:630-232-0637
Practice Address - Street 1:415 W STATE ST
Practice Address - Street 2:
Practice Address - City:GENEVA
Practice Address - State:IL
Practice Address - Zip Code:60134-2157
Practice Address - Country:US
Practice Address - Phone:630-232-0650
Practice Address - Fax:630-232-0637
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-26
Last Update Date:2012-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL054007941332B00000X
IL054-0079413336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL206993Medicare PIN
IL0201270001Medicare NSC