MEDICARE: KEVIN M RILEY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	26017192A	IN

General Provider Information

NPI Number	:	1427651827
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEVIN M RILEY

Provider Business Mailing Address
First Line	:	PO BOX 394
Second Line	:
City	:	SHELBYVILLE
State	:	IN
Zip	:	46176-0394
Country	:	US
Telephone Number	:	765-346-1440
Fax Number	:

Provider Business Practice Location Address
First Line	:	10001 E WASHINGTON ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46229-2623
Country	:	US
Telephone Number	:	317-897-6323
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/18/2020
Last Update Date	:	11/18/2020

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Directions to “ KEVIN M RILEY ” Practice Location

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