Provider Demographics
NPI:1649242298
Name:RILEY, DEBRA JUNE (RPH)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:JUNE
Last Name:RILEY
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:322 W WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:ARTESIA
Mailing Address - State:NM
Mailing Address - Zip Code:88210-2866
Mailing Address - Country:US
Mailing Address - Phone:505-746-3591
Mailing Address - Fax:505-746-6673
Practice Address - Street 1:322 W WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:ARTESIA
Practice Address - State:NM
Practice Address - Zip Code:88210-2866
Practice Address - Country:US
Practice Address - Phone:505-746-3591
Practice Address - Fax:505-746-6673
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM4621183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist