Provider Demographics
NPI:1891031340
Name:RIVERTOWN PHARMACY INC
Entity Type:Organization
Organization Name:RIVERTOWN PHARMACY INC
Other - Org Name:RIVERTOWN PHARMACY INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:THELBERT
Authorized Official - Middle Name:DALE
Authorized Official - Last Name:TODD
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:843-488-4400
Mailing Address - Street 1:2000 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:SC
Mailing Address - Zip Code:29526-3335
Mailing Address - Country:US
Mailing Address - Phone:843-488-4400
Mailing Address - Fax:800-881-4793
Practice Address - Street 1:2000 MAIN ST
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:SC
Practice Address - Zip Code:29526-3335
Practice Address - Country:US
Practice Address - Phone:843-488-4400
Practice Address - Fax:843-488-4401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-02
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0003X
SC143233336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC14323OtherSTATE PHARMACY PERMIT