Healthcare Provider Details

I. General information

NPI: 1144845009
Provider Name (Legal Business Name): RIVERWALK PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2020
Last Update Date: 06/16/2020
Certification Date: 06/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4234 RIVERWALK PKWY STE 130
RIVERSIDE CA
92505-3304
US

IV. Provider business mailing address

4234 RIVERWALK PKWY STE 130
RIVERSIDE CA
92505-3304
US

V. Phone/Fax

Practice location:
  • Phone: 951-352-3030
  • Fax: 951-352-3040
Mailing address:
  • Phone: 951-352-3030
  • Fax: 951-352-3040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3336M0003X
TaxonomyManaged Care Organization Pharmacy
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: TAPAN PATEL
Title or Position: PHARMACIST IN CHARGE/CFO
Credential: PHARMD
Phone: 951-352-3030