Provider Demographics
NPI:1003370057
Name:RIAAN PHARMACY LLC
Entity Type:Organization
Organization Name:RIAAN PHARMACY LLC
Other - Org Name:POLK COMMUNITY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:SAMIR
Authorized Official - Middle Name:
Authorized Official - Last Name:DHADUK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:863-816-5151
Mailing Address - Street 1:4040 SUNSET LAKE DR
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33810-2841
Mailing Address - Country:US
Mailing Address - Phone:863-816-5151
Mailing Address - Fax:
Practice Address - Street 1:2105 NEW TAMPA HWY
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33815-7364
Practice Address - Country:US
Practice Address - Phone:863-816-5151
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-24
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy