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General NPI Number Information
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NPI Number | 1801443114
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Entity Type | Individual
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Provider Name | SUSAN DIANE RILES R.PH.
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Gender | Female
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Dates
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Enumeration Date | 08/21/2019
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Last Update Date | 08/21/2019
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Provider Practice Location Address
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Address Line | 1235 MAIN ST
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City | SOUTHAVEN
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State | MS
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Zip | 38671-1429
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Country | US
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Telephone | 877-864-7952
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Fax |
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Provider Business Mailing Address
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Address Line | 5713 HIGHWAY 178 E
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City | POTTS CAMP
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State | MS
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Zip | 38659-9237
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Country | US
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Telephone | 662-544-9420
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | E08347
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License Number State | MS
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