Provider Demographics
NPI:1033473616
Name:RIVER PHARMACY LLC
Entity Type:Organization
Organization Name:RIVER PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:OSMAN
Authorized Official - Middle Name:Z
Authorized Official - Last Name:OSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-344-9755
Mailing Address - Street 1:PO BOX 100310
Mailing Address - Street 2:RIVER PHARMACY
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33910-0310
Mailing Address - Country:US
Mailing Address - Phone:239-257-2651
Mailing Address - Fax:239-257-2653
Practice Address - Street 1:1708 CAPE CORAL PKWY W
Practice Address - Street 2:UNIT 12
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33914-6985
Practice Address - Country:US
Practice Address - Phone:239-257-2651
Practice Address - Fax:239-257-2653
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-28
Last Update Date:2012-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH26165333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy