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General NPI Number Information
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NPI Number | 1497994594
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Entity Type | Organization
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Legal Business Name | RIVERSIDE HEALTHCARE SERVICES
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Dates
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Enumeration Date | 02/12/2009
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Last Update Date | 08/27/2012
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Provider Practice Location Address
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Address Line | 1300 MACTAVISH AVE
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City | RICHMOND
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State | VA
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Zip | 23230-4633
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Country | US
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Telephone | 804-977-5901
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Fax | 804-977-5910
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Provider Business Mailing Address
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Address Line | 1300 MACTAVISH AVE
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City | RICHMOND
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State | VA
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Zip | 23230-4633
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Country | US
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Telephone | 804-977-5901
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Fax | 804-977-5910
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MIKE BOGGS
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Credential |
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Telephone | 757-594-4600
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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 | 0201004270
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License Number State | VA
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