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General NPI Number Information
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NPI Number | 1033280409
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Entity Type | Organization
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Legal Business Name | RIVERSIDE PHARMACY & COMPOUNDING
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Dates
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Enumeration Date | 11/10/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 9448 MAGNOLIA AVE SUITE B
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City | RIVERSIDE
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State | CA
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Zip | 92503
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Country | US
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Telephone | 951-343-1633
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Fax | 951-343-1675
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Provider Business Mailing Address
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Address Line | 9448 MAGNOLIA AVE SUITE B
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City | RIVERSIDE
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State | CA
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Zip | 92503
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Country | US
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Telephone | 951-343-1633
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Fax | 951-343-1675
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Authorized Official
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Title or Position | PHARMACIST IN CHARGE
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Name | MS. KELLY NHUNG TUYET LUU
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Credential | PHARMD
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Telephone | 951-343-1633
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PHY46716
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License Number State | CA
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