Provider Demographics
NPI:1164433652
Name:RIVER OAK PHARMACEUTICAL CARE INC
Entity Type:Organization
Organization Name:RIVER OAK PHARMACEUTICAL CARE INC
Other - Org Name:RIVER OAK PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:COSNER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:209-847-2226
Mailing Address - Street 1:1080 W F ST
Mailing Address - Street 2:STE D
Mailing Address - City:OAKDALE
Mailing Address - State:CA
Mailing Address - Zip Code:95361-3677
Mailing Address - Country:US
Mailing Address - Phone:209-847-2226
Mailing Address - Fax:209-847-2241
Practice Address - Street 1:1080 W F ST
Practice Address - Street 2:STE D
Practice Address - City:OAKDALE
Practice Address - State:CA
Practice Address - Zip Code:95361-3677
Practice Address - Country:US
Practice Address - Phone:209-847-2226
Practice Address - Fax:209-847-2241
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X
CAPHY449413336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1999390OtherPK
CAPHA449410Medicaid
CAPHA449410Medicaid