Provider Demographics
NPI:1053967018
Name:WORL, RILEY
Entity type:Individual
Prefix:DR
First Name:RILEY
Middle Name:
Last Name:WORL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1109 E 9TH ST APT 2
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:IN
Mailing Address - Zip Code:46975-1957
Mailing Address - Country:US
Mailing Address - Phone:765-480-6254
Mailing Address - Fax:
Practice Address - Street 1:850 N PLYMOUTH RD
Practice Address - Street 2:
Practice Address - City:WINAMAC
Practice Address - State:IN
Practice Address - Zip Code:46996-1124
Practice Address - Country:US
Practice Address - Phone:574-946-3553
Practice Address - Fax:574-946-3923
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-15
Last Update Date:2019-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26028371A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist