Provider Demographics
NPI:1942755731
Name:DETHIER, RILEY (PHARMD)
Entity Type:Individual
Prefix:
First Name:RILEY
Middle Name:
Last Name:DETHIER
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LE ROY
Mailing Address - State:NY
Mailing Address - Zip Code:14482-1317
Mailing Address - Country:US
Mailing Address - Phone:585-768-2300
Mailing Address - Fax:585-768-0818
Practice Address - Street 1:151 W MAIN ST
Practice Address - Street 2:
Practice Address - City:LE ROY
Practice Address - State:NY
Practice Address - Zip Code:14482-1317
Practice Address - Country:US
Practice Address - Phone:585-768-2300
Practice Address - Fax:585-768-0818
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-22
Last Update Date:2016-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY061513183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY061513OtherNYS LICENSE