Provider Demographics
NPI:1790834521
Name:RILEY, DAVID (MBA)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:
Last Name:RILEY
Suffix:
Gender:M
Credentials:MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:730 S POTOMAC ST
Mailing Address - Street 2:
Mailing Address - City:WAYNESBORO
Mailing Address - State:PA
Mailing Address - Zip Code:17268-2198
Mailing Address - Country:US
Mailing Address - Phone:717-762-1164
Mailing Address - Fax:717-762-2206
Practice Address - Street 1:730 S POTOMAC ST
Practice Address - Street 2:
Practice Address - City:WAYNESBORO
Practice Address - State:PA
Practice Address - Zip Code:17268-2198
Practice Address - Country:US
Practice Address - Phone:717-762-1164
Practice Address - Fax:717-762-2206
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP032047L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist