Provider Demographics
NPI:1679169072
Name:RIVIELLO, ROBERT T (RPH)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:T
Last Name:RIVIELLO
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 1:1385 HUNTINGTON LN
Mailing Address - Street 2:
Mailing Address - City:DALTON
Mailing Address - State:PA
Mailing Address - Zip Code:18414-9164
Mailing Address - Country:US
Mailing Address - Phone:570-351-4124
Mailing Address - Fax:
Practice Address - Street 1:921 DRINKER TPKE STE 24
Practice Address - Street 2:
Practice Address - City:COVINGTON TOWNSHIP
Practice Address - State:PA
Practice Address - Zip Code:18444-7948
Practice Address - Country:US
Practice Address - Phone:570-842-7848
Practice Address - Fax:570-842-2435
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-19
Last Update Date:2020-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP-045569-L183500000X
PARP045569L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist