MEDICARE: RIVERSIDE PHARMACY DBA CANAL PHARMACY

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	333600000X	Pharmacy	01335	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1538208095
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RIVERSIDE PHARMACY DBA CANAL PHARMACY

Provider Business Mailing Address
First Line	:	2502 CANAL ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77003-1523
Country	:	US
Telephone Number	:	713-227-5583
Fax Number	:	713-224-1918

Provider Business Practice Location Address
First Line	:	2502 CANAL ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77003-1523
Country	:	US
Telephone Number	:	713-227-5583
Fax Number	:	713-224-1918

Authorized Official
Title or Position	:	OWNER CHIEF PHARMACIST
Name	:	CLAUDIA PADILLA
Credential	:	RPH
Telephone Number	:	713-227-5583

Provider Enumeration Date	:	02/05/2007
Last Update Date	:	08/22/2020

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