Healthcare Provider Details

I. General information

NPI: 1184657397
Provider Name (Legal Business Name): RIVER VALE PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

653 WESTWOOD AVE
RIVERVALE NJ
07675-6238
US

IV. Provider business mailing address

653 WESTWOOD AVE
RIVER VALE NJ
07675
US

V. Phone/Fax

Practice location:
  • Phone: 201-664-5553
  • Fax: 201-664-0905
Mailing address:
  • Phone: 201-664-5553
  • Fax: 201-664-0905

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 Number
License Number StateNJ

VIII. Authorized Official

Name: EDITH Y CHIU
Title or Position: PHARMACIST-IN-CHARGE
Credential: R.PH
Phone: 201-664-5553