Provider Demographics
NPI:1932269511
Name:RIVERSIDE PHARMACY, INC.
Entity Type:Organization
Organization Name:RIVERSIDE PHARMACY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:SAJJAD
Authorized Official - Middle Name:
Authorized Official - Last Name:HOSSAIN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:256-546-3784
Mailing Address - Street 1:401 S 1ST ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:GADSDEN
Mailing Address - State:AL
Mailing Address - Zip Code:35901-5358
Mailing Address - Country:US
Mailing Address - Phone:256-546-3784
Mailing Address - Fax:256-546-3786
Practice Address - Street 1:401 S 1ST ST
Practice Address - Street 2:SUITE B
Practice Address - City:GADSDEN
Practice Address - State:AL
Practice Address - Zip Code:35901-5358
Practice Address - Country:US
Practice Address - Phone:256-546-3784
Practice Address - Fax:256-546-3786
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2010-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL111651183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1314510001Medicare NSC