Provider Demographics
NPI:1548032063
Name:CULVER, RIELLY JAMES (PHARMD)
Entity type:Individual
Prefix:DR
First Name:RIELLY
Middle Name:JAMES
Last Name:CULVER
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 1:11553 S BLACK OAK TRL
Mailing Address - Street 2:
Mailing Address - City:BATTLE GROUND
Mailing Address - State:IN
Mailing Address - Zip Code:47920-8050
Mailing Address - Country:US
Mailing Address - Phone:765-426-0389
Mailing Address - Fax:
Practice Address - Street 1:512 SAGAMORE PKWY W
Practice Address - Street 2:
Practice Address - City:WEST LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47906-1458
Practice Address - Country:US
Practice Address - Phone:765-497-3551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-27
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX73424183500000X
IN26031010A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist