Organization
RIVER VALLEY PHCY AND SUPPLY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN SIMONTON (PRESIDENT)
(731) 968-2661
Entity
Organization
Contact information
Practice address
58 S MAIN ST, LEXINGTON, TN 38351-2104
(731) 968-2661
(731) 968-3230
Mailing address
58 S MAIN ST, LEXINGTON, TN 38351-2104
Taxonomy
Speciality
Code
Description
License number
State
3336L0003X
Long Term Care Pharmacy
Primary
3638
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4434851
OTHER ID NUMBER-COMMERCIAL NUMBER
—
05
—
4434851
—
TN
Enumeration date
08/10/2006
Last updated
08/22/2020
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