Provider Demographics
NPI:1649464785
Name:RISO, PETER A JR (RPH)
Entity type:Individual
Prefix:MR
First Name:PETER
Middle Name:A
Last Name:RISO
Suffix:JR
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:6435 ALIANTE PKWY
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89084-3196
Mailing Address - Country:US
Mailing Address - Phone:702-657-6508
Mailing Address - Fax:702-657-8466
Practice Address - Street 1:6435 ALIANTE PKWY
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89084-3196
Practice Address - Country:US
Practice Address - Phone:702-657-6508
Practice Address - Fax:702-657-8466
Is Sole Proprietor?:No
Enumeration Date:2007-08-31
Last Update Date:2007-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV15162183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist