Provider Demographics
NPI:1700642253
Name:RIVER ROAD PHARMACY
Entity Type:Organization
Organization Name:RIVER ROAD PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:RAPERT
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:870-838-5750
Mailing Address - Street 1:1741 HWY 61 SOUTH
Mailing Address - Street 2:
Mailing Address - City:OSCEOLA
Mailing Address - State:AR
Mailing Address - Zip Code:72370
Mailing Address - Country:US
Mailing Address - Phone:870-563-0777
Mailing Address - Fax:870-563-0327
Practice Address - Street 1:1741 HWY 61 SOUTH
Practice Address - Street 2:
Practice Address - City:OSCEOLA
Practice Address - State:AR
Practice Address - Zip Code:72370
Practice Address - Country:US
Practice Address - Phone:870-563-0777
Practice Address - Fax:870-563-0327
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RIVER ROAD PHARMACY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-02-22
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR305629407Medicaid