Provider Demographics
NPI:1851432116
Name:RIVER CHEMISTS CORP.
Entity Type:Organization
Organization Name:RIVER CHEMISTS CORP.
Other - Org Name:D.J. DRUGS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SUPERVISING PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:VYACHESLAV
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAMALOV
Authorized Official - Suffix:
Authorized Official - Credentials:BS PHARM
Authorized Official - Phone:718-549-6709
Mailing Address - Street 1:3721 RIVERDALE AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-1807
Mailing Address - Country:US
Mailing Address - Phone:718-549-6709
Mailing Address - Fax:718-549-1422
Practice Address - Street 1:3721 RIVERDALE AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463-1807
Practice Address - Country:US
Practice Address - Phone:718-549-6709
Practice Address - Fax:718-549-1422
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
NY0284013336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00727922Medicaid
NY02877549Medicaid
NY02877549Medicaid