Provider Demographics
NPI:1396262218
Name:RIVERVIEW PHARMACY LLC
Entity type:Organization
Organization Name:RIVERVIEW PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:MAHMOUD
Authorized Official - Middle Name:
Authorized Official - Last Name:SROUR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-445-5656
Mailing Address - Street 1:7633 E JEFFERSON AVE STE 130
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48214-3730
Mailing Address - Country:US
Mailing Address - Phone:313-499-8900
Mailing Address - Fax:248-564-5419
Practice Address - Street 1:7633 E JEFFERSON AVE STE 130
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48214-3730
Practice Address - Country:US
Practice Address - Phone:313-499-8900
Practice Address - Fax:248-564-5419
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-23
Last Update Date:2018-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53010112413336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy