Provider Demographics
NPI:1629823208
Name:RIVERDALE PHARMACY LLC
Entity Type:Organization
Organization Name:RIVERDALE PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:TUSHAR
Authorized Official - Middle Name:
Authorized Official - Last Name:BALAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:551-998-4909
Mailing Address - Street 1:3547 JOHNSON AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-1602
Mailing Address - Country:US
Mailing Address - Phone:718-395-3509
Mailing Address - Fax:718-395-5695
Practice Address - Street 1:3547 JOHNSON AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463-1602
Practice Address - Country:US
Practice Address - Phone:718-395-3509
Practice Address - Fax:718-395-5695
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-18
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy