MEDICARE: JOE W RILEY RPH

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
1	183500000X	Pharmacist	17050	TX

General Provider Information

NPI Number	:	1871591636
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOE W RILEY RPH

Provider Business Mailing Address
First Line	:	116 S PARK DR
Second Line	:
City	:	BROWNWOOD
State	:	TX
Zip	:	76801-5918
Country	:	US
Telephone Number	:	325-646-9414
Fax Number	:	325-646-8275

Provider Business Practice Location Address
First Line	:	116 S PARK DR
Second Line	:
City	:	BROWNWOOD
State	:	TX
Zip	:	76801-5918
Country	:	US
Telephone Number	:	325-646-9414
Fax Number	:	325-646-8275

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/14/2005
Last Update Date	:	07/08/2007

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