Organization
RIVERSIDE PHARMACY LLC
Active
Other names
RIVERSIDE PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
SANJAY L RAYATHATHA (MEMBER/OWNER)
(410) 742-1188
Entity
Organization
Contact information
Practice address
540 RIVERSIDE DR, SALISBURY, MD 21801-5352
(410) 742-1188
(410) 742-3408
Mailing address
540 RIVERSIDE DR STE 1, SALISBURY, MD 21801-5352
(410) 742-1188
(410) 742-3408
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
P00296
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
040752600
—
MD
01
—
2032824
PK
—
05
—
473628100
—
MD
Enumeration date
09/20/2006
Last updated
04/03/2020
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