Provider Demographics
NPI:1538208095
Name:RIVERSIDE PHARMACY DBA CANAL PHARMACY
Entity type:Organization
Organization Name:RIVERSIDE PHARMACY DBA CANAL PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER CHIEF PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:CLAUDIA
Authorized Official - Middle Name:
Authorized Official - Last Name:PADILLA
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:713-227-5583
Mailing Address - Street 1:2502 CANAL ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77003-1523
Mailing Address - Country:US
Mailing Address - Phone:713-227-5583
Mailing Address - Fax:713-224-1918
Practice Address - Street 1:2502 CANAL ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77003-1523
Practice Address - Country:US
Practice Address - Phone:713-227-5583
Practice Address - Fax:713-224-1918
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX01335333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX143064Medicaid
TX4522149Medicare ID - Type UnspecifiedNABP NUMBER