Organization
RIVERSIDE PROFESSIONAL DRUG INC
Active
Organization
RIVERSIDE PROFESSIONAL DRUG INC
Active
Other names
RIVERSIDE SAVMOR PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
STEPHEN GRAHAM (MANAGER PHARMACY SERVICES)
(248) 348-1570
Entity
Organization
Contact information
Practice address
2801 W JEFFERSON AVE, TRENTON, MI 48183-2901
(734) 676-3784
(734) 676-3793
Mailing address
43155 W 9 MILE RD, NOVI, MI 48375-4190
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
5301003409
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2327648
OTHER ID NUMBER
—
05
—
2327648
—
MI
Enumeration date
08/27/2006
Last updated
08/19/2008
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