Provider Demographics
NPI:1528570587
Name:RIVERVIEW RX LLC
Entity Type:Organization
Organization Name:RIVERVIEW RX LLC
Other - Org Name:RIVERVIEW RX
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BILAL
Authorized Official - Middle Name:
Authorized Official - Last Name:ABI KHODR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-675-4455
Mailing Address - Street 1:20980 GRANGE RD
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:MI
Mailing Address - Zip Code:48193-7962
Mailing Address - Country:US
Mailing Address - Phone:313-675-4455
Mailing Address - Fax:
Practice Address - Street 1:20980 GRANGE RD
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:MI
Practice Address - Zip Code:48193-7962
Practice Address - Country:US
Practice Address - Phone:313-675-4455
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-31
Last Update Date:2017-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5301011265333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy