Provider Demographics
NPI:1811637739
Name:FLAVIN, RIANE (CPHT)
Entity type:Individual
Prefix:MS
First Name:RIANE
Middle Name:
Last Name:FLAVIN
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2145 ROOSEVELT AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01104-1650
Mailing Address - Country:US
Mailing Address - Phone:413-504-4495
Mailing Address - Fax:413-504-5495
Practice Address - Street 1:802 WILLIAMS ST
Practice Address - Street 2:
Practice Address - City:LONGMEADOW
Practice Address - State:MA
Practice Address - Zip Code:01106-2049
Practice Address - Country:US
Practice Address - Phone:413-567-0679
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-30
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPT12322183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician