Organization
RIDER PHARMACY INC
Active
Other names
RIDER PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
JONATHAN RIDER (OWNER)
(304) 366-2710
Entity
Organization
Contact information
Practice address
303 MERCHANT ST, FAIRMONT, WV 26554-5213
(304) 366-2710
(304) 366-3116
Mailing address
303 MERCHANT STREET, FAIRMONT, WV 26555-2138
(304) 366-2710
(304) 366-3201
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
AR5100792
WV
3336C0003X
Community/Retail Pharmacy
—
—
3336C0004X
Compounding Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
014225200
—
WV
05
—
042783001
—
WV
01
—
5001019
OTHER ID NUMBER
—
Enumeration date
07/05/2005
Last updated
06/07/2017
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