Provider Demographics
NPI:1053894196
Name:RIVERWALK PHARMACY LLC
Entity type:Organization
Organization Name:RIVERWALK PHARMACY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:MARWA
Authorized Official - Middle Name:
Authorized Official - Last Name:SAMAHA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-312-5353
Mailing Address - Street 1:63 BARBARA ST
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07003-4001
Mailing Address - Country:US
Mailing Address - Phone:862-400-7897
Mailing Address - Fax:908-312-5354
Practice Address - Street 1:665 MARINSVILLE RD UNITE 9B
Practice Address - Street 2:
Practice Address - City:BASKING RIDGE
Practice Address - State:NJ
Practice Address - Zip Code:07920
Practice Address - Country:US
Practice Address - Phone:862-400-7897
Practice Address - Fax:908-312-5354
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-14
Last Update Date:2018-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy