MEDICARE: RIVERSIDE PHARMACY SOLUTIONS

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	183500000X	Pharmacist

General Provider Information

NPI Number	:	1992536361
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RIVERSIDE PHARMACY SOLUTIONS

Provider Business Mailing Address
First Line	:	393 LEDFORD ISLAND RD NW
Second Line	:
City	:	CHARLESTON
State	:	TN
Zip	:	37310-5213
Country	:	US
Telephone Number	:	423-710-0024
Fax Number	:	423-961-8089

Provider Business Practice Location Address
First Line	:	393 LEDFORD ISLAND RD NW
Second Line	:
City	:	CHARLESTON
State	:	TN
Zip	:	37310-5213
Country	:	US
Telephone Number	:	423-710-0024
Fax Number	:	423-961-8089

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MICHAEL JOHN BIRDWELL
Credential	:	PHARMD
Telephone Number	:	423-710-0024

Provider Enumeration Date	:	08/08/2024
Last Update Date	:	08/08/2024

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