Riverside SRX Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

030384 Issued in NY

Legal business name

RIVERSIDE SRX INC

Doing business as

Riverside Pharmacy

Practice address

2920 Frederick Douglass Blvd
New York, NY 10039-1610

Phone

(212) 491-5500

Fax

(212) 491-5501

NPI assigned

Jul 9, 2010

Organization subpart

No

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

Authorized official

Name

Vamsidhar Vasireddy

Title

President

Phone

(212) 491-5500

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Riverside Pharmacy Doing business as

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

Locations

Practitioners 1

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

• Mohan Vodoor, RPH

  • Pharmacist
  • New York, NY
  • NPI 1326289349
  NPD (past)

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

{
    "created_epoch": "1278633600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598918400000",
    "number": "1760794440",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2920 FREDERICK DOUGLASS BLVD",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100391610",
            "telephone_number": "212-491-5500",
            "fax_number": "212-491-5501"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2920 FREDERICK DOUGLASS BLVD",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100391610",
            "telephone_number": "212-491-5500",
            "fax_number": "212-491-5501"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RIVERSIDE SRX INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-07-09",
        "last_updated": "2020-09-01",
        "certification_date": "2020-09-01",
        "status": "A",
        "authorized_official_last_name": "VASIREDDY",
        "authorized_official_first_name": "VAMSIDHAR",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "212-491-5500"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NY",
            "license": "030384",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP PROVIDER IDENTIFICATION NUMBER",
            "identifier": "5801724",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Riverside Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Riverside Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Jacynthe Rivest, M.D.
• Rivia Medical PLLC
• Rivia Medical PLLC

• Community/Retail Pharmacy in New York, NY
• Providers in New York, NY by specialty
• Community/Retail Pharmacy in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 1, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.