Provider Demographics
NPI:1518239482
Name:RIVERBANK PHARMACY INC
Entity Type:Organization
Organization Name:RIVERBANK PHARMACY INC
Other - Org Name:RIVERBANK PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WESLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:YONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-863-9988
Mailing Address - Street 1:8801 OAK VIEW CT
Mailing Address - Street 2:
Mailing Address - City:OAKDALE
Mailing Address - State:CA
Mailing Address - Zip Code:95361-9240
Mailing Address - Country:US
Mailing Address - Phone:209-848-1688
Mailing Address - Fax:
Practice Address - Street 1:2603 PATTERSON RD STE 9
Practice Address - Street 2:
Practice Address - City:RIVERBANK
Practice Address - State:CA
Practice Address - Zip Code:95367-3407
Practice Address - Country:US
Practice Address - Phone:209-863-9988
Practice Address - Fax:209-863-1212
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-07
Last Update Date:2016-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY507943336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2133757OtherPK