MEDICARE: MR. PETER A RISO JR. RPH

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	15162	NV

General Provider Information

NPI Number	:	1649464785
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. PETER A RISO JR. RPH

Provider Business Mailing Address
First Line	:	6435 ALIANTE PKWY
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89084-3196
Country	:	US
Telephone Number	:	702-657-6508
Fax Number	:	702-657-8466

Provider Business Practice Location Address
First Line	:	6435 ALIANTE PKWY
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89084-3196
Country	:	US
Telephone Number	:	702-657-6508
Fax Number	:	702-657-8466

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

Provider Enumeration Date	:	08/31/2007
Last Update Date	:	08/31/2007

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