Organization
RIVERSIDE DISCOUNT PHARMACY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHRISTOPHER MUOMAH (PRESIDENT)
(770) 732-9342
Entity
Organization
Contact information
Practice address
705 S GORDON RD, STE A, MABLETON, GA 30126
(770) 732-9342
(770) 732-9347
Mailing address
705 S GORDON RD, STE A, MABLETON, GA 30126
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
007401
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00506965B
—
GA
01
—
1136933
OTHER ID NUMBER
—
Enumeration date
01/03/2007
Last updated
09/12/2007
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