Healthcare Provider Details

I. General information

NPI: 1548275977
Provider Name (Legal Business Name): RIVER PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 04/04/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 AMES ST
ELK RAPIDS MI
49629-9449
US

IV. Provider business mailing address

124 AMES ST
ELK RAPIDS MI
49629-9449
US

V. Phone/Fax

Practice location:
  • Phone: 231-264-8165
  • Fax: 231-264-0234
Mailing address:
  • Phone: 231-264-8165
  • Fax: 231-264-0234

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 Number5301002970
License Number StateMI

VIII. Authorized Official

Name: LOUIS GHIRINGHELLI
Title or Position: PRESIDENT
Credential:
Phone: 231-264-8165