Provider Demographics
NPI:1841626637
Name:ARRIOLA, TONY KENNETH (RPH)
Entity type:Individual
Prefix:
First Name:TONY
Middle Name:KENNETH
Last Name:ARRIOLA
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1200
Mailing Address - Street 2:
Mailing Address - City:BANDON
Mailing Address - State:OR
Mailing Address - Zip Code:97411-1200
Mailing Address - Country:US
Mailing Address - Phone:541-290-7634
Mailing Address - Fax:541-267-1712
Practice Address - Street 1:230 E JOHNSON AVE
Practice Address - Street 2:
Practice Address - City:COOS BAY
Practice Address - State:OR
Practice Address - Zip Code:97420-1478
Practice Address - Country:US
Practice Address - Phone:541-267-1709
Practice Address - Fax:541-267-1712
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-24
Last Update Date:2016-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH-00073831835P0018X, 183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist