Organization
RIVERSIDE PHARMACY INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CAMERON KEITH HATFIELD R PH (OWNER)
(304) 682-8132
Entity
Organization
Contact information
Practice address
22 LARRY JOE HARLESS, GILBERT, WV 25621
(304) 664-3343
Mailing address
PO BOX 431, GILBERT, WV 25621-0431
(304) 664-3343
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
SP0552340
WV
3336C0003X
Community/Retail Pharmacy
Primary
SP0552340
WV
Other
Enumeration date
04/23/2007
Last updated
10/20/2008
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