River City Pharmacy Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

6057 Issued in TN

Legal business name

RIVER CITY PHARMACY INC

Practice address

5564 Little Debbie Pkwy
Suite 102
Ooltewah, TN 37363-4356

Phone

(423) 521-7279

Fax

(423) 498-2480

NPI assigned

Aug 27, 2017

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

James Goss, RPHNPI 1922310168

Title

Owner/Pic/Ao

Phone

(423) 503-1243

Specialties & licenses 3

Addresses

Other identifiers 2

Other names 1

• River City Pharmacy Doing business as

Medicare fee-for-service enrollment

Enrolled in TN

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• James Walter Goss, PHARMD

  • Pharmacist
  • Ooltewah, TN
  • NPI 1922310168
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1503792000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1531958400000",
    "number": "1144747411",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5564 LITTLE DEBBIE PKWY",
            "address_2": "SUITE 102",
            "city": "OOLTEWAH",
            "state": "TN",
            "postal_code": "373634356",
            "telephone_number": "423-521-7279",
            "fax_number": "423-498-2480"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5564 LITTLE DEBBIE PKWY",
            "address_2": "SUITE 102",
            "city": "OOLTEWAH",
            "state": "TN",
            "postal_code": "373634356",
            "telephone_number": "423-521-7279",
            "fax_number": "423-498-2480"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RIVER CITY PHARMACY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-08-27",
        "last_updated": "2018-07-19",
        "status": "A",
        "authorized_official_last_name": "GOSS",
        "authorized_official_first_name": "JAMES",
        "authorized_official_title_or_position": "OWNER/PIC/AO",
        "authorized_official_telephone_number": "423-503-1243",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "TN",
            "license": "6057",
            "primary": true
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "Q035490",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2171095",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "River City Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Dina Williams Rogers
• Kaitlyn Eldridge Rogers

• Community/Retail Pharmacy in Ooltewah, TN
• Providers in Ooltewah, TN by specialty
• Community/Retail Pharmacy in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.