Provider Demographics
NPI:1326806969
Name:RIVERSIDE PHARMACY LLC
Entity Type:Organization
Organization Name:RIVERSIDE PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:SANJAY
Authorized Official - Middle Name:L
Authorized Official - Last Name:RAYATHATHA
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMACIST
Authorized Official - Phone:410-948-0554
Mailing Address - Street 1:540 RIVERSIDE DR STE 1
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21801-5375
Mailing Address - Country:US
Mailing Address - Phone:410-742-1188
Mailing Address - Fax:410-742-3408
Practice Address - Street 1:540 RIVERSIDE DR STE 1
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21801-5375
Practice Address - Country:US
Practice Address - Phone:410-742-1188
Practice Address - Fax:410-742-3408
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-08
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy