Provider Demographics
NPI:1780732925
Name:RIVERWALK PHARMACY INC.
Entity type:Organization
Organization Name:RIVERWALK PHARMACY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST-IN-CHARGE
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:BRIGHT
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:843-645-2600
Mailing Address - Street 1:149 RIVERWALK BLVD
Mailing Address - Street 2:SUITE 10
Mailing Address - City:RIDGELAND
Mailing Address - State:SC
Mailing Address - Zip Code:29936-8190
Mailing Address - Country:US
Mailing Address - Phone:843-645-2600
Mailing Address - Fax:
Practice Address - Street 1:149 RIVERWALK BLVD
Practice Address - Street 2:SUITE 10
Practice Address - City:RIDGELAND
Practice Address - State:SC
Practice Address - Zip Code:29936-8190
Practice Address - Country:US
Practice Address - Phone:843-645-2600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC50009125333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC779850Medicaid
SC4225517OtherNABP