=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225478092
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RIVERVIEW PHARMACY & SURGICALS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/26/2013
-----------------------------------------------------
Last Update Date | 09/24/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 410 EASTERN BLVD
-----------------------------------------------------
City | ESSEX
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21221-6714
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 443-231-5177
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 410 EASTERN BLVD
-----------------------------------------------------
City | ESSEX
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21221-6714
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 443-231-5177
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGING PHARMACIST
-----------------------------------------------------
Name | VINAY DASARI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 443-231-5177
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number | P05998
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------