MEDICARE: JENNIFER RIVOR PHARM.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	63750	CA

General Provider Information

NPI Number	:	1508143058
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER RIVOR PHARM.D.

Provider Business Mailing Address
First Line	:	1400 BEAUMONT AVE
Second Line	:
City	:	BEAUMONT
State	:	CA
Zip	:	92223-4704
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1400 BEAUMONT AVE
Second Line	:
City	:	BEAUMONT
State	:	CA
Zip	:	92223-4704
Country	:	US
Telephone Number	:	951-769-4295
Fax Number	:	951-769-4649

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/11/2011
Last Update Date	:	11/11/2011

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