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General NPI Number Information
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NPI Number | 1740584705
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Entity Type | Organization
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Legal Business Name | RIVER'S EDGE PHARMACY, LLC
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Dates
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Enumeration Date | 01/05/2011
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Last Update Date | 01/05/2011
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Provider Practice Location Address
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Address Line | 503 FM 359 RD STE 180
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City | RICHMOND
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State | TX
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Zip | 77406-5196
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Country | US
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Telephone | 281-232-3662
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Fax | 281-232-3692
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Provider Business Mailing Address
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Address Line | 1860 FM 359 RD # 230
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City | RICHMOND
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State | TX
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Zip | 77406-1296
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Country | US
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Telephone | 281-250-6911
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Fax | 281-232-3692
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Authorized Official
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Title or Position | PHARMACIST-IN-CHIEF
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Name | MRS. SHANTAE SHEPARD AKPAFFIONG
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Credential | RPH
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Telephone | 281-232-3662
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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 | 40301
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License Number State | TX
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