Healthcare Provider Details

I. General information

NPI: 1588779516
Provider Name (Legal Business Name): RIVERVIEW PHARMACIES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 06/09/2022
Certification Date: 06/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

475 BROWN BLVD SUITE 105
BOURBONNAIS IL
60914-2325
US

IV. Provider business mailing address

475 BROWN BLVD SUITE 105
BOURBONNAIS IL
60914-2325
US

V. Phone/Fax

Practice location:
  • Phone: 815-933-1735
  • Fax: 815-933-3370
Mailing address:
  • Phone: 815-933-1735
  • Fax: 815-933-3370

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number054006576
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: JOHN HALL
Title or Position: MANAGER
Credential:
Phone: 815-933-1735