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General NPI Number Information
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NPI Number | 1518239482
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Entity Type | Organization
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Legal Business Name | RIVERBANK PHARMACY INC
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Dates
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Enumeration Date | 02/07/2012
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Last Update Date | 07/08/2016
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Provider Practice Location Address
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Address Line | 2603 PATTERSON RD STE 9
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City | RIVERBANK
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State | CA
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Zip | 95367-3407
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Country | US
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Telephone | 209-863-9988
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Fax | 209-863-1212
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Provider Business Mailing Address
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Address Line | 8801 OAK VIEW CT
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City | OAKDALE
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State | CA
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Zip | 95361-9240
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Country | US
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Telephone | 209-848-1688
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | WESLEY YONG
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Credential |
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Telephone | 209-863-9988
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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 | PHY50794
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License Number State | CA
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