Healthcare Provider Details

I. General information

NPI: 1235967415
Provider Name (Legal Business Name): RIVER MEDLIN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2024
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

490 HOSPITAL DR
CLYDE NC
28721-8026
US

IV. Provider business mailing address

490 HOSPITAL DR
CLYDE NC
28721-8026
US

V. Phone/Fax

Practice location:
  • Phone: 828-692-4289
  • Fax:
Mailing address:
  • Phone: 828-692-4289
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number33248
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number700754
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: