Provider Demographics
NPI:1538887500
Name:RIVER OAK PHARMACY
Entity type:Organization
Organization Name:RIVER OAK PHARMACY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:TAREQ
Authorized Official - Middle Name:AHMAD
Authorized Official - Last Name:AL MUGHAZZEZ
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:209-847-2226
Mailing Address - Street 1:1080 W F ST STE D
Mailing Address - Street 2:
Mailing Address - City:OAKDALE
Mailing Address - State:CA
Mailing Address - Zip Code:95361-3677
Mailing Address - Country:US
Mailing Address - Phone:209-847-2226
Mailing Address - Fax:209-847-2241
Practice Address - Street 1:1080 W F ST STE D
Practice Address - Street 2:
Practice Address - City:OAKDALE
Practice Address - State:CA
Practice Address - Zip Code:95361-3677
Practice Address - Country:US
Practice Address - Phone:209-847-2226
Practice Address - Fax:209-847-2241
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-16
Last Update Date:2024-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHY59988OtherPHARMACY PERMIT
1164433652OtherNPI