Provider Demographics
NPI:1992049126
Name:RIVERCARE SOLUTIONS LLC
Entity type:Organization
Organization Name:RIVERCARE SOLUTIONS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VISWA PRAKASH
Authorized Official - Middle Name:VARMA
Authorized Official - Last Name:MANTENA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-757-0200
Mailing Address - Street 1:51 HEARTHSTONE LN
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-5366
Mailing Address - Country:US
Mailing Address - Phone:856-757-0200
Mailing Address - Fax:856-757-0211
Practice Address - Street 1:1787 RIVER RD
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:NJ
Practice Address - Zip Code:08105-4215
Practice Address - Country:US
Practice Address - Phone:856-757-0200
Practice Address - Fax:856-757-0200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-09
Last Update Date:2024-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RS007227003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6725420001Medicare NSC