Healthcare Provider Details

I. General information

NPI: 1689586307
Provider Name (Legal Business Name): KENNA RILEY PHARMD
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/18/2026
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 STEVENS ST
NORWALK CT
06850-3852
US

IV. Provider business mailing address

36 MOTT HILL RD
EAST HAMPTON CT
06424-1327
US

V. Phone/Fax

Practice location:
  • Phone: 203-852-2690
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0017499
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: