MEDICARE: RIVER CHEMISTS CORP.

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	332B00000X	Durable Medical Equipment & Medical Supplies
2	3336C0003X	Community/Retail Pharmacy	028401	NY

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1851432116
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RIVER CHEMISTS CORP.

Provider Business Mailing Address
First Line	:	3721 RIVERDALE AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10463-1807
Country	:	US
Telephone Number	:	718-549-6709
Fax Number	:	718-549-1422

Provider Business Practice Location Address
First Line	:	3721 RIVERDALE AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10463-1807
Country	:	US
Telephone Number	:	718-549-6709
Fax Number	:	718-549-1422

Authorized Official
Title or Position	:	SUPERVISING PHARMACIST
Name	:	MR. VYACHESLAV SHAMALOV
Credential	:	BS PHARM
Telephone Number	:	718-549-6709

Provider Enumeration Date	:	02/09/2007
Last Update Date	:	11/30/2023

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Directions to “RIVER CHEMISTS CORP. ” Practice Location

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