Provider Demographics
NPI:1588779516
Name:RIVERVIEW PHARMACIES INC
Entity type:Organization
Organization Name:RIVERVIEW PHARMACIES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-933-1735
Mailing Address - Street 1:475 BROWN BLVD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:BOURBONNAIS
Mailing Address - State:IL
Mailing Address - Zip Code:60914-2325
Mailing Address - Country:US
Mailing Address - Phone:815-933-1735
Mailing Address - Fax:815-933-3370
Practice Address - Street 1:475 BROWN BLVD
Practice Address - Street 2:SUITE 105
Practice Address - City:BOURBONNAIS
Practice Address - State:IL
Practice Address - Zip Code:60914-2325
Practice Address - Country:US
Practice Address - Phone:815-933-1735
Practice Address - Fax:815-933-3370
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336L0003X, 333600000X
IL0540065763336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL3622974344001Medicaid
2022525OtherPK
IL3622974344001Medicaid
PA001904611Medicaid
NJ0086479Medicaid
IA0593939Medicaid
IL3622974344001Medicaid
KY7100032890Medicaid
MN03065800Medicaid
TX1588779516Medicaid
5351240001Medicare NSC
1406493OtherOTHER ID NUMBER-COMMERCIAL NUMBER
UT1588779516Medicaid