Provider Demographics
NPI:1861003741
Name:RILEY, CHRISTINA DIANE (PHARMD)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:DIANE
Last Name:RILEY
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:517 JESSIE ST
Mailing Address - Street 2:
Mailing Address - City:KELLER
Mailing Address - State:TX
Mailing Address - Zip Code:76248-3331
Mailing Address - Country:US
Mailing Address - Phone:972-971-2974
Mailing Address - Fax:
Practice Address - Street 1:4350 OAK PARK LN
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76109-1512
Practice Address - Country:US
Practice Address - Phone:817-902-0600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-13
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX65038183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist