Organization
RIVERSIDE PHARMACY INC
Active
Other names
RIVERSIDE PHARMACY INC
Organization subpart
No
Provider details
NPI number
Authorized official
SCOTTIE BARTON (OWNER)
(770) 532-6253
Entity
Organization
Contact information
Practice address
935 GREEN ST NW, GAINESVILLE, GA 30501-3325
(770) 532-6203
(770) 532-3692
Mailing address
935 GREEN ST NW, GAINESVILLE, GA 30501-3325
(770) 532-6203
(770) 532-3692
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHRE006669
GA
3336L0003X
Long Term Care Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000035109A
—
GA
01
—
2127695
PK
—
Enumeration date
11/07/2006
Last updated
09/01/2016
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