Organization
RIVERWEST PHARMACY LLC
Active
Other names
RiverWest Pharmacy LLC
Organization subpart
No
Provider details
NPI number
Authorized official
NADER ATIEH (PHARMACIST IN CHARGE-OWNER)
(815) 614-3837
Entity
Organization
Contact information
Practice address
165 S CURTIS AVE, KANKAKEE, IL 60901-3218
(815) 614-3837
(815) 614-3317
Mailing address
165 S CURTIS AVE, KANKAKEE, IL 60901-3218
(815) 614-3837
(815) 614-3317
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
054017672
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1485590
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
05/12/2011
Last updated
05/25/2011
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