Healthcare Provider Details

I. General information

NPI: 1003198243
Provider Name (Legal Business Name): THOMAS C RIORDAN PHARM D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2011
Last Update Date: 09/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ZUNI HOSPITAL - RT. 301 N. B. AVE
ZUNI NM
87327-0467
US

IV. Provider business mailing address

PO BOX 467 ROUTE 301 NORTH B. AVENUE
ZUNI NM
87327-0467
US

V. Phone/Fax

Practice location:
  • Phone: 505-782-7518
  • Fax:
Mailing address:
  • Phone: 505-782-7518
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number45900
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: