Provider Demographics
NPI:1821540378
Name:RIOS, LUCY
Entity Type:Individual
Prefix:
First Name:LUCY
Middle Name:
Last Name:RIOS
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:LUCY
Other - Middle Name:
Other - Last Name:RIOS-MCNULTY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:BSC
Mailing Address - Street 1:9304 BALM RIVERVIEW RD
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33569-5104
Mailing Address - Country:US
Mailing Address - Phone:813-677-6000
Mailing Address - Fax:813-677-6077
Practice Address - Street 1:9304 BALM RIVERVIEW RD
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33569-5104
Practice Address - Country:US
Practice Address - Phone:813-677-6000
Practice Address - Fax:813-677-6077
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-01
Last Update Date:2016-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS29887183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPS29887OtherBOARD OF PHARMACY