Provider Demographics
NPI:1316088677
Name:RILEY, MARK STEVEN (PHARM D)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:STEVEN
Last Name:RILEY
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19300 RILEY RD
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72206-9485
Mailing Address - Country:US
Mailing Address - Phone:501-888-4391
Mailing Address - Fax:
Practice Address - Street 1:20381 ARCH ST
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72206-9218
Practice Address - Country:US
Practice Address - Phone:501-888-2830
Practice Address - Fax:501-888-3118
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR06288183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist