Healthcare Provider Details

I. General information

NPI: 1740498088
Provider Name (Legal Business Name): KATHLEEN M RILEY PHARM D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

K-MART PHARMACY #7460 6906 MANARDVILLE PIKE NE
KNOXVILLE TN
37918
US

IV. Provider business mailing address

3800 OAK VALLEY DR APT#125
KNOXVILLE TN
37918-5176
US

V. Phone/Fax

Practice location:
  • Phone: 865-922-7443
  • Fax: 865-922-1604
Mailing address:
  • Phone: 570-313-9965
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number22508
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: