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NPI Code Detail

MEDICARE: KEVIN RILEY

MEDICARE: KEVIN RILEY
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacistPS47122FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1PS47122OTHERFLFLORIDA PHAMACIST LICENSE

General Provider Information

NPI Number : 1235535014
Entity Type Code : Individual
Provider Name (Legal Business Name) : KEVIN RILEY
Provider Business Mailing Address
First Line : 9500 GRAND BLVD.
Second Line :
City : MIRAMAR BEACH
State : FL
Zip : 32550
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2038 US HIGHWAY 98 W
Second Line :
City : SANTA ROSA BEACH
State : FL
Zip : 32459-5322
Country : US
Telephone Number : 850-267-1166
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/06/2014
Last Update Date : 11/06/2014

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Directions to “ KEVIN RILEY ” Practice Location

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