Provider Demographics
NPI:1881666923
Name:GENE A RILEY & THOMAS C RILEY PTRS
Entity Type:Organization
Organization Name:GENE A RILEY & THOMAS C RILEY PTRS
Other - Org Name:LEBANON SHOPS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:RILEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-344-6700
Mailing Address - Street 1:300 MOUNT LEBANON BLVD
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15234-1512
Mailing Address - Country:US
Mailing Address - Phone:412-344-6700
Mailing Address - Fax:412-344-5223
Practice Address - Street 1:300 MOUNT LEBANON BLVD
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15234-1512
Practice Address - Country:US
Practice Address - Phone:412-344-6700
Practice Address - Fax:412-344-5223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-02
Last Update Date:2015-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
PAPP413537L3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2084162OtherPK
PA0918425Medicaid
0597080001Medicare NSC