Healthcare Provider Details

I. General information

NPI: 1215874540
Provider Name (Legal Business Name): RIVERSIDE RX PHARMACY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2026
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3527 BROADWAY
NEW YORK NY
10031-5627
US

IV. Provider business mailing address

3527 BROADWAY
NEW YORK NY
10031-5627
US

V. Phone/Fax

Practice location:
  • Phone: 212-256-0488
  • Fax:
Mailing address:
  • Phone:
  • 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: JIWON AN
Title or Position: PRESIDENT
Credential:
Phone: 212-256-0488