Provider Demographics
NPI:1730475112
Name:RIVERSIDE PHARMACY ASSOCIATES LLC
Entity Type:Organization
Organization Name:RIVERSIDE PHARMACY ASSOCIATES LLC
Other - Org Name:APEX SPECIALTY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:
Authorized Official - Last Name:EMO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-741-8844
Mailing Address - Street 1:616 NW PLATTE VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:MO
Mailing Address - Zip Code:64150-9798
Mailing Address - Country:US
Mailing Address - Phone:816-741-8844
Mailing Address - Fax:816-741-8849
Practice Address - Street 1:616 NW PLATTE VALLEY DR
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:MO
Practice Address - Zip Code:64150-9798
Practice Address - Country:US
Practice Address - Phone:816-741-8844
Practice Address - Fax:816-741-8849
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-23
Last Update Date:2013-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20110228793336C0003X
3336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2130839OtherPK
MO606572501Medicaid