Reviva Compounding Pharmacy LLC

Primary specialty

Compounding PharmacyTaxonomy code 3336C0004X

Legal business name

REVIVA COMPOUNDING PHARMACY LLC

Practice address

1664 Fort St
Lincoln Park, MI 48146-1909

Phone

(313) 384-0484

NPI assigned

Sep 18, 2026

Last updated

Sep 18, 2026By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Mary Beydoun, PHARMDNPI 1558077719

Title

Owner/Pharmacist in Charge

Phone

(313) 701-2261

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Mary Robert Beydoun, RPH

  • Pharmacist
  • San Diego, CA
  • NPI 1558077719
  Authorized official Same address or phone

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

{
    "created_epoch": "1789689600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1789689600000",
    "number": "1487566279",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1664 FORT ST",
            "city": "LINCOLN PARK",
            "state": "MI",
            "postal_code": "481461909",
            "telephone_number": "313-384-0484"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1664 FORT ST",
            "city": "LINCOLN PARK",
            "state": "MI",
            "postal_code": "481461909",
            "telephone_number": "313-384-0484"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVIVA COMPOUNDING PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2026-09-18",
        "last_updated": "2026-09-18",
        "certification_date": "2026-09-17",
        "status": "A",
        "authorized_official_last_name": "BEYDOUN",
        "authorized_official_first_name": "MARY",
        "authorized_official_title_or_position": "OWNER/PHARMACIST IN CHARGE",
        "authorized_official_telephone_number": "313-701-2261",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHARMD"
    },
    "taxonomies": [
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Timothy Joseph Rayba, CPSS
• Sherry Lynn Razo, BACHELORS DEGREE
• Remedy Physical Therapy and Rehabilitation Inc. (Remedy Physical Therapy Rehabilitation Center)
• Kristina Marie Renaud, B.S., R.S.S.T
• Felix Antonio Rentas, CHW
• Charles Nolan Rice, MSW/LMSW
• William S Rich, DDS
• Erin Rigelman
• Rite Health Pharmacy Fort LLC
• Kenya Rivers-Fuller, LLMSW

• Compounding Pharmacy in Lincoln Park, MI
• Providers in Lincoln Park, MI by specialty
• Compounding Pharmacy in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.