Healthcare Provider Details

I. General information

NPI: 1669203261
Provider Name (Legal Business Name): RIVERBEND PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2024
Last Update Date: 08/15/2024
Certification Date: 08/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14916 TELEGRAPH RD
FLAT ROCK MI
48134-9661
US

IV. Provider business mailing address

14916 TELEGRAPH RD
FLAT ROCK MI
48134-9661
US

V. Phone/Fax

Practice location:
  • Phone: 734-897-9701
  • Fax:
Mailing address:
  • Phone: 734-897-9701
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: SARITHA JOE
Title or Position: PHARMACY MANAGER
Credential:
Phone: 734-897-9701