Provider Demographics
NPI:1689104663
Name:RILEY, MITSUE
Entity Type:Individual
Prefix:
First Name:MITSUE
Middle Name:
Last Name:RILEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1840 COLUMBUS PIKE
Mailing Address - Street 2:
Mailing Address - City:DELAWARE
Mailing Address - State:OH
Mailing Address - Zip Code:43015-2728
Mailing Address - Country:US
Mailing Address - Phone:740-363-0035
Mailing Address - Fax:740-363-7643
Practice Address - Street 1:1840 COLUMBUS PIKE
Practice Address - Street 2:
Practice Address - City:DELAWARE
Practice Address - State:OH
Practice Address - Zip Code:43015-2728
Practice Address - Country:US
Practice Address - Phone:740-363-0035
Practice Address - Fax:740-363-7643
Is Sole Proprietor?:No
Enumeration Date:2017-06-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03120991183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist