MEDICARE: RIVERSIDE COMMUNITY PHARMACY, INC.

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	PH26403	FL
2	3336C0003X	Community/Retail Pharmacy

General Provider Information

NPI Number	:	1629320825
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RIVERSIDE COMMUNITY PHARMACY, INC.

Provider Business Mailing Address
First Line	:	RIVERSIDE COMMUNITY PHARMACY, INC.
Second Line	:	1456 NW 17TH AVE
City	:	MIAMI
State	:	FL
Zip	:	33125
Country	:	US
Telephone Number	:	305-549-6677
Fax Number	:	305-549-6633

Provider Business Practice Location Address
First Line	:	RIVERSIDE COMMUNITY PHARMACY, INC.
Second Line	:	1456 NW 17TH AVE
City	:	MIAMI
State	:	FL
Zip	:	33125
Country	:	US
Telephone Number	:	305-549-6677
Fax Number	:	305-549-6633

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MICHAEL P GARCIA
Credential	:
Telephone Number	:	305-549-6677

Provider Enumeration Date	:	10/11/2012
Last Update Date	:	04/19/2019

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