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General NPI Number Information
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NPI Number | 1013014935
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Entity Type | Organization
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Legal Business Name | RIVERSIDE PHARMACY LLC
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Dates
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Enumeration Date | 09/20/2006
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Last Update Date | 04/03/2020
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Provider Practice Location Address
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Address Line | 540 RIVERSIDE DR
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City | SALISBURY
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State | MD
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Zip | 21801-5352
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Country | US
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Telephone | 410-742-1188
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Fax | 410-742-3408
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Provider Business Mailing Address
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Address Line | 540 RIVERSIDE DR STE 1
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City | SALISBURY
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State | MD
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Zip | 21801-5352
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Country | US
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Telephone | 410-742-1188
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Fax | 410-742-3408
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Authorized Official
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Title or Position | MEMBER/OWNER
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Name | SANJAY L RAYATHATHA
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Credential |
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Telephone | 410-742-1188
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | P00296
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License Number State | MD
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