MEDICARE: RIVERCITY COMMUNITY PHARMACY AND WELLNESS CENTER

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	PENDING	FL

General Provider Information

NPI Number	:	1669642377
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RIVERCITY COMMUNITY PHARMACY AND WELLNESS CENTER

Provider Business Mailing Address
First Line	:	P O BOX 7205
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32238
Country	:	US
Telephone Number	:	904-502-1882
Fax Number	:

Provider Business Practice Location Address
First Line	:	7278 LEM TURNER RD
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32208
Country	:	US
Telephone Number	:	904-502-1882
Fax Number	:

Authorized Official
Title or Position	:	PHARMACY MANAGER/OWNER
Name	:	DR. YOLANDA L RIVERS
Credential	:	PHARMD
Telephone Number	:	904-502-1882

Provider Enumeration Date	:	03/10/2008
Last Update Date	:	03/10/2008

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Directions to “RIVERCITY COMMUNITY PHARMACY AND WELLNESS CENTER ” Practice Location

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