Provider Demographics
NPI:1710006135
Name:RILEY, KIM PATRICK (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:KIM
Middle Name:PATRICK
Last Name:RILEY
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1845 W A ST
Mailing Address - Street 2:
Mailing Address - City:NORTH PLATTE
Mailing Address - State:NE
Mailing Address - Zip Code:69101-4534
Mailing Address - Country:US
Mailing Address - Phone:308-532-5539
Mailing Address - Fax:308-532-3784
Practice Address - Street 1:1845 W A ST
Practice Address - Street 2:
Practice Address - City:NORTH PLATTE
Practice Address - State:NE
Practice Address - Zip Code:69101-4534
Practice Address - Country:US
Practice Address - Phone:308-532-5539
Practice Address - Fax:308-532-3784
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2018-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE9286183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist