Provider Demographics
NPI:1760625453
Name:RILEY, GRACE EVELYN (RPH)
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:EVELYN
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 1:1900 E 8 MILE RD
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48234-1008
Mailing Address - Country:US
Mailing Address - Phone:313-892-4600
Mailing Address - Fax:313-892-3753
Practice Address - Street 1:1900 E 8 MILE RD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48234-1008
Practice Address - Country:US
Practice Address - Phone:313-892-4600
Practice Address - Fax:313-892-3753
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-12
Last Update Date:2009-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302410569183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist