Healthcare Provider Details

I. General information

NPI: 1033280409
Provider Name (Legal Business Name): RIVERSIDE PHARMACY & COMPOUNDING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9448 MAGNOLIA AVE SUITE B
RIVERSIDE CA
92503
US

IV. Provider business mailing address

9448 MAGNOLIA AVE SUITE B
RIVERSIDE CA
92503
US

V. Phone/Fax

Practice location:
  • Phone: 951-343-1633
  • Fax: 951-343-1675
Mailing address:
  • Phone: 951-343-1633
  • Fax: 951-343-1675

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHY46716
License Number StateCA

VIII. Authorized Official

Name: MS. KELLY NHUNG TUYET LUU
Title or Position: PHARMACIST IN CHARGE
Credential: PHARMD
Phone: 951-343-1633