MEDICARE: RIVERTOWN 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	3336C0003X	Community/Retail Pharmacy
2	333600000X	Pharmacy	14323	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2123572	OTHER		PK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1902136260
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RIVERTOWN PHARMACY INC

Provider Business Mailing Address
First Line	:	2000 MAIN ST
Second Line	:
City	:	CONWAY
State	:	SC
Zip	:	29526-3335
Country	:	US
Telephone Number	:	843-488-4400
Fax Number	:	800-881-4793

Provider Business Practice Location Address
First Line	:	2000 MAIN ST
Second Line	:
City	:	CONWAY
State	:	SC
Zip	:	29526-3335
Country	:	US
Telephone Number	:	843-488-4400
Fax Number	:	800-881-4793

Authorized Official
Title or Position	:	PHARMACIST
Name	:	LESLIE TODD
Credential	:	RPH
Telephone Number	:	843-488-4400

Provider Enumeration Date	:	01/10/2010
Last Update Date	:	02/03/2025

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Directions to “RIVERTOWN PHARMACY INC ” Practice Location

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