Provider Demographics
NPI:1144845009
Name:RIVERWALK PHARMACY
Entity type:Organization
Organization Name:RIVERWALK PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST IN CHARGE/CFO
Authorized Official - Prefix:
Authorized Official - First Name:TAPAN
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:951-352-3030
Mailing Address - Street 1:4234 RIVERWALK PKWY STE 130
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92505-3304
Mailing Address - Country:US
Mailing Address - Phone:951-352-3030
Mailing Address - Fax:951-352-3040
Practice Address - Street 1:4234 RIVERWALK PKWY STE 130
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92505-3304
Practice Address - Country:US
Practice Address - Phone:951-352-3030
Practice Address - Fax:951-352-3040
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SHRI HARI RX INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-06-16
Last Update Date:2020-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336M0003XSuppliersPharmacyManaged Care Organization Pharmacy