Individual provider Active NPI

Khristine S Lariviere, RPH

  • Pharmacist
  • Uncasville, CT
National Provider Identifier
1912273194
Registry record updated Jan 31, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
3455 Issued in NH
Practice address
67 Sandy Desert Rd
Uncasville, CT 06382-1111
Phone
(855) 664-4679
Fax
(860) 862-9099
NPI assigned
Apr 1, 2012
Last updated
Jan 31, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 31, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 15

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X 3455 NH Primary
Pharmacist 183500000X 18362 KY
Pharmacist 183500000X 18120 AL
Pharmacist 183500000X PH232932 MA
Pharmacist 183500000X S021075 AZ
Pharmacist 183500000X RPH04838 RI
Pharmacist 183500000X 202212884 VA
Pharmacist 183500000X 59689 TX
Pharmacist 183500000X 37926 TN
Pharmacist 183500000X RPH-0014832 OR
Pharmacist 183500000X PST.021988 LA
Pharmacist 183500000X 16737 OK
Pharmacist 183500000X MD23345 MD
Pharmacist 183500000X PCT.0011317 CT
Pharmacist 183500000X T-13794 MS

Addresses

Primary practice location

67 Sandy Desert Rd
Uncasville, CT 06382-1111

Mailing address

58 Tum a Lum Cir
Westerly, RI 02891-3156
Phone (860) 460-6743

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Registered Pharmacist

State licenses

LicenseStateTypeSpecialty
59689TXMDClinical Social Worker
18120ALMDPharmacist
S021075AZMDPharmacist
PCT.0011317CTMDPharmacist
18362KYMDPharmacist
PST.021988LAMDPharmacist
PH232932MAMDPharmacist
MD23345MDMDPharmacist
T-13794MSMDPharmacist
16737OKMDPharmacist
RPH-0014832ORMDPharmacist
RPH04838RIMDPharmacist
202212884VAMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Mohegan Tribe of Indians of CT Current Accepting new patients
Mohegan Tribe of Indians of Connecticut Current Accepting new patients

Locations

67 Sandy Desert Rd
Uncasville, CT 06382
Phone (855) 664-4679

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1333238400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1643587200000",
    "number": "1912273194",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "58 TUM A LUM CIR",
            "city": "WESTERLY",
            "state": "RI",
            "postal_code": "028913156",
            "telephone_number": "860-460-6743"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "67 SANDY DESERT RD",
            "city": "UNCASVILLE",
            "state": "CT",
            "postal_code": "063821111",
            "telephone_number": "855-664-4679",
            "fax_number": "860-862-9099"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LARIVIERE",
        "first_name": "KHRISTINE",
        "middle_name": "S",
        "credential": "RPH",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-04-01",
        "last_updated": "2022-01-31",
        "certification_date": "2022-01-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "NH",
            "license": "3455",
            "primary": true
        },
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "KY",
            "license": "18362",
            "primary": false
        },
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "AL",
            "license": "18120",
            "primary": false
        },
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "MA",
            "license": "PH232932",
            "primary": false
        },
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "AZ",
            "license": "S021075",
            "primary": false
        },
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "RI",
            "license": "RPH04838",
            "primary": false
        },
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "VA",
            "license": "202212884",
            "primary": false
        },
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "TX",
            "license": "59689",
            "primary": false
        },
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "TN",
            "license": "37926",
            "primary": false
        },
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "OR",
            "license": "RPH-0014832",
            "primary": false
        },
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "LA",
            "license": "PST.021988",
            "primary": false
        },
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "OK",
            "license": "16737",
            "primary": false
        },
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "MD",
            "license": "MD23345",
            "primary": false
        },
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "CT",
            "license": "PCT.0011317",
            "primary": false
        },
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "MS",
            "license": "T-13794",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Uncasville, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.