Provider Demographics
NPI:1184657397
Name:RIVER VALE PHARMACY INC
Entity Type:Organization
Organization Name:RIVER VALE PHARMACY INC
Other - Org Name:MEDICINE SHOPPE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST-IN-CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:EDITH
Authorized Official - Middle Name:Y
Authorized Official - Last Name:CHIU
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:201-664-5553
Mailing Address - Street 1:653 WESTWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:RIVER VALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07675
Mailing Address - Country:US
Mailing Address - Phone:201-664-5553
Mailing Address - Fax:201-664-0905
Practice Address - Street 1:653 WESTWOOD AVE
Practice Address - Street 2:
Practice Address - City:RIVERVALE
Practice Address - State:NJ
Practice Address - Zip Code:07675-6238
Practice Address - Country:US
Practice Address - Phone:201-664-5553
Practice Address - Fax:201-664-0905
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NJ3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3123849OtherNCPDP #
NJ4370601Medicaid
NJ4370601Medicaid
NJ3123849OtherNCPDP #