Healthcare Provider Details

I. General information

NPI: 1891031340
Provider Name (Legal Business Name): RIVERTOWN PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2013
Last Update Date: 09/20/2023
Certification Date: 09/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 MAIN ST
CONWAY SC
29526-3335
US

IV. Provider business mailing address

2000 MAIN ST
CONWAY SC
29526-3335
US

V. Phone/Fax

Practice location:
  • Phone: 843-488-4400
  • Fax: 843-488-4401
Mailing address:
  • Phone: 843-488-4400
  • Fax: 800-881-4793

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 Number14323
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MR. THELBERT DALE TODD JR.
Title or Position: OWNER
Credential:
Phone: 843-488-4400