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TAILOR ILISE RILEY

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PHARMD

Contact information

Practice address
2010 COUNTRY CLUB RD, LAKE CHARLES, LA 70605-5206
(337) 990-4902
Mailing address
168 ALLEN MARCANTEL RD, KINDER, LA 70648-5438
(337) 496-5451

Taxonomy

Speciality
Code
Description
License number
State
1835P0018X
Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
Primary
PST.022506
LA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
MA.003770
LOUISIANA BOARD OF PHARMACY
LA
01
PST.022506
LOUISIANA BOARD OF PHARMACY
LA
Enumeration date
08/27/2018
Last updated
08/27/2018
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