MEDICARE: DR. GAYLE LATISHA RIVERS PHARMD

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	13111	SC

General Provider Information

NPI Number	:	1013214295
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GAYLE LATISHA RIVERS PHARMD

Provider Business Mailing Address
First Line	:	1228 KNOX AVE
Second Line	:
City	:	NORTH AUGUSTA
State	:	SC
Zip	:	29841-4055
Country	:	US
Telephone Number	:	803-279-3279
Fax Number	:	803-279-0871

Provider Business Practice Location Address
First Line	:	1228 KNOX AVE
Second Line	:
City	:	NORTH AUGUSTA
State	:	SC
Zip	:	29841-4055
Country	:	US
Telephone Number	:	803-279-3279
Fax Number	:	803-279-0871

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

Provider Enumeration Date	:	02/23/2011
Last Update Date	:	02/23/2011

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