Provider Demographics
NPI:1447743992
Name:KHOURY, RIWA (PHARMD)
Entity Type:Individual
Prefix:
First Name:RIWA
Middle Name:
Last Name:KHOURY
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:RI
Mailing Address - Zip Code:02809-4402
Mailing Address - Country:US
Mailing Address - Phone:401-339-3640
Mailing Address - Fax:
Practice Address - Street 1:677 MAIN RD
Practice Address - Street 2:
Practice Address - City:TIVERTON
Practice Address - State:RI
Practice Address - Zip Code:02878-1352
Practice Address - Country:US
Practice Address - Phone:401-624-8411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-10
Last Update Date:2018-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRPH04847183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist