Organization
RIVERSIDE PHARMACY 2 LLC
Active
Other names
RIVERSIDE PHARMACY 2
Organization subpart
No
Provider details
NPI number
Authorized official
SAMUEL RANDOLPH BALLENGEE PHARMD (PHARMACIST)
(304) 664-3343
Entity
Organization
Contact information
Practice address
22 LARRY JOE HARLESS DRIVE, GILBERT, WV 25621
(304) 664-3343
(304) 664-8307
Mailing address
PO BOX 431, 22 LARRY JOE HARLESS DRIVE, GILBERT, WV 25621
(304) 664-3343
(304) 664-8307
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Enumeration date
03/18/2025
Last updated
03/18/2025
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