Provider Demographics
NPI:1932399383
Name:SOUTH RIVER COMPOUNDING PHARMACY WEST END, INC.
Entity Type:Organization
Organization Name:SOUTH RIVER COMPOUNDING PHARMACY WEST END, INC.
Other - Org Name:SOUTH RIVER COMPOUNDING PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:BAYLOR
Authorized Official - Last Name:RICE
Authorized Official - Suffix:JR
Authorized Official - Credentials:RPH
Authorized Official - Phone:804-897-6447
Mailing Address - Street 1:3656 MAYLAND CT
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23233-1409
Mailing Address - Country:US
Mailing Address - Phone:804-897-6447
Mailing Address - Fax:804-967-6449
Practice Address - Street 1:3656 MAYLAND CT
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23233-1409
Practice Address - Country:US
Practice Address - Phone:804-897-6447
Practice Address - Fax:804-967-6449
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-31
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0201004172333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy