MEDICARE: RIVERS PHARMACY INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy	50003060	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4219057	OTHER		NCPDP PROVIDER IDENTIFICATION NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1851337349
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RIVERS PHARMACY INC

Provider Business Mailing Address
First Line	:	12927 MAIN ST
Second Line	:
City	:	WILLISTON
State	:	SC
Zip	:	29853-2321
Country	:	US
Telephone Number	:	803-266-7010
Fax Number	:	803-266-3370

Provider Business Practice Location Address
First Line	:	12927 MAIN ST
Second Line	:
City	:	WILLISTON
State	:	SC
Zip	:	29853-2321
Country	:	US
Telephone Number	:	803-266-7010
Fax Number	:	803-266-3370

Authorized Official
Title or Position	:	PRESIDENT
Name	:	THOMAS RIVERS
Credential	:
Telephone Number	:	803-266-7010

Provider Enumeration Date	:	06/21/2006
Last Update Date	:	06/25/2012

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Directions to “RIVERS PHARMACY INC ” Practice Location

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