Provider Demographics
NPI:1740584705
Name:RIVER'S EDGE PHARMACY, LLC
Entity Type:Organization
Organization Name:RIVER'S EDGE PHARMACY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST-IN-CHIEF
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHANTAE
Authorized Official - Middle Name:SHEPARD
Authorized Official - Last Name:AKPAFFIONG
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:281-232-3662
Mailing Address - Street 1:1860 FM 359 RD # 230
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77406-1296
Mailing Address - Country:US
Mailing Address - Phone:281-250-6911
Mailing Address - Fax:281-232-3692
Practice Address - Street 1:503 FM 359 RD STE 180
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77406-5196
Practice Address - Country:US
Practice Address - Phone:281-232-3662
Practice Address - Fax:281-232-3692
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-05
Last Update Date:2011-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX403013336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy