Provider Demographics
NPI:1457869588
Name:ANTOUN RIAD, CAROLINE RIAD (REGISTERED PHARMACIS)
Entity Type:Individual
Prefix:
First Name:CAROLINE
Middle Name:RIAD
Last Name:ANTOUN RIAD
Suffix:
Gender:F
Credentials:REGISTERED PHARMACIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1473 LAWFORD ST
Mailing Address - Street 2:
Mailing Address - City:GLENDORA
Mailing Address - State:CA
Mailing Address - Zip Code:91741-3757
Mailing Address - Country:US
Mailing Address - Phone:626-756-2528
Mailing Address - Fax:
Practice Address - Street 1:1473 LAWFORD ST
Practice Address - Street 2:
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91741-3757
Practice Address - Country:US
Practice Address - Phone:626-756-2528
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-10
Last Update Date:2018-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA78061183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist