Provider Demographics
NPI:1992536361
Name:RIVERSIDE PHARMACY SOLUTIONS
Entity type:Organization
Organization Name:RIVERSIDE PHARMACY SOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:BIRDWELL
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:423-710-0024
Mailing Address - Street 1:393 LEDFORD ISLAND RD NW
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:TN
Mailing Address - Zip Code:37310-5213
Mailing Address - Country:US
Mailing Address - Phone:423-710-0024
Mailing Address - Fax:423-961-8089
Practice Address - Street 1:393 LEDFORD ISLAND RD NW
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:TN
Practice Address - Zip Code:37310-5213
Practice Address - Country:US
Practice Address - Phone:423-710-0024
Practice Address - Fax:423-961-8089
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-08
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty