Provider Demographics
NPI:1922429109
Name:SLOKOM LLC
Entity Type:Organization
Organization Name:SLOKOM LLC
Other - Org Name:RIVERWALK PHARMACY # 2
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PIC
Authorized Official - Prefix:
Authorized Official - First Name:NIMESH
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:951-371-5070
Mailing Address - Street 1:4234 RIVERWALK PKWY
Mailing Address - Street 2:SUITE 130
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92505-8510
Mailing Address - Country:US
Mailing Address - Phone:951-352-3030
Mailing Address - Fax:
Practice Address - Street 1:6987 HAMNER AVE STE 4
Practice Address - Street 2:
Practice Address - City:EASTVALE
Practice Address - State:CA
Practice Address - Zip Code:92880-3810
Practice Address - Country:US
Practice Address - Phone:951-371-5070
Practice Address - Fax:951-371-5080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-14
Last Update Date:2016-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
CA517023336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1922429109Medicaid
2143460OtherPK