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General NPI Number Information
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NPI Number | 1104421056
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Entity Type | Individual
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Provider Name | JANE GADDIS RIVENBARK RPH
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Gender | Female
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Dates
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Enumeration Date | 11/30/2020
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Last Update Date | 11/30/2020
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Provider Practice Location Address
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Address Line | 1022 HARDY RD
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City | VINTON
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State | VA
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Zip | 24179-2241
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Country | US
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Telephone | 540-345-9851
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Fax | 540-345-3679
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Provider Business Mailing Address
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Address Line | 3258 WHITE OAK RD SW
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City | ROANOKE
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State | VA
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Zip | 24014-1428
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Country | US
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Telephone | 540-904-5033
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1835P0018X
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Taxonomy Name | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
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License Number | 0202010047
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License Number State | VA
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