Healthcare Provider Details

I. General information

NPI: 1447743992
Provider Name (Legal Business Name): RIWA KHOURY PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2018
Last Update Date: 06/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

677 MAIN RD
TIVERTON RI
02878-1352
US

IV. Provider business mailing address

18 HARRISON ST
BRISTOL RI
02809-4402
US

V. Phone/Fax

Practice location:
  • Phone: 401-624-8411
  • Fax:
Mailing address:
  • Phone: 401-339-3640
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH04847
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: