# RIVERSIDE MOT PHARMACY INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** RIVERSIDE MOT PHARMACY INC
- **Organization subpart:** No

## Provider details

- **NPI number:** 1982761706
- **Authorized official:** SCOTTIE BARTON (CEO AND PRESIDENT)
- **Authorized official phone:** (770) 532-6253

## Contact information

- **Practice address:** 935-B GREEN ST, GAINESVILLE, GA 30501
- **Practice address phone:** (770) 532-6253
- **Practice address fax:** (770) 532-3692
- **Mailing address:** 935-B GREEN ST, GAINESVILLE, GA 30501
- **Mailing address phone:** (770) 532-6253
- **Mailing address fax:** (770) 532-3692

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336L0003X | Long Term Care Pharmacy | 008828 | GA | Yes |

## Other

- **Enumeration date:** 01/02/2007
- **Last updated:** 09/24/2015

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 2015567 | PK | — |
| 05 | — | 609612415A | — | GA |