Healthcare Provider Details

I. General information

NPI: 1225034960
Provider Name (Legal Business Name): CY JAMES RIFFLE PHARM. D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HCR 6100 BOX 30
TEEC NOS POS AZ
86514
US

IV. Provider business mailing address

15717 COUNTY RD. 35
MANCOS CO
81328
US

V. Phone/Fax

Practice location:
  • Phone: 928-656-5285
  • Fax: 928-656-5162
Mailing address:
  • Phone: 928-656-5285
  • Fax: 928-656-5162

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH020898
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: