Provider Demographics
NPI:1407258346
Name:RIVERSIDE REMEDIES RX CORP.
Entity Type:Organization
Organization Name:RIVERSIDE REMEDIES RX CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GENE
Authorized Official - Middle Name:W
Authorized Official - Last Name:BURNS
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:845-887-3030
Mailing Address - Street 1:39 LOWER MAIN ST
Mailing Address - Street 2:P.O. BOX 275
Mailing Address - City:CALLICOON
Mailing Address - State:NY
Mailing Address - Zip Code:12723-5000
Mailing Address - Country:US
Mailing Address - Phone:845-887-3030
Mailing Address - Fax:845-887-3179
Practice Address - Street 1:39 LOWER MAIN ST
Practice Address - Street 2:
Practice Address - City:CALLICOON
Practice Address - State:NY
Practice Address - Zip Code:12723-5000
Practice Address - Country:US
Practice Address - Phone:845-887-3030
Practice Address - Fax:845-887-3179
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-23
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0330783336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0442Medicaid
NY7328620001Medicare NSC