Provider Demographics
NPI:1609147164
Name:RILEY, WENDEL (RPH)
Entity Type:Individual
Prefix:
First Name:WENDEL
Middle Name:
Last Name:RILEY
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:SPENCER
Mailing Address - State:IA
Mailing Address - Zip Code:51301-3631
Mailing Address - Country:US
Mailing Address - Phone:712-262-0231
Mailing Address - Fax:
Practice Address - Street 1:800 GRAND AVE
Practice Address - Street 2:
Practice Address - City:SPENCER
Practice Address - State:IA
Practice Address - Zip Code:51301-3631
Practice Address - Country:US
Practice Address - Phone:712-262-0231
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-14
Last Update Date:2012-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA13532183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist