Healthcare Provider Details

I. General information

NPI: 1083578512
Provider Name (Legal Business Name): ALICE RIVARD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/10/2025
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

189 STORRS RD
MANSFIELD CENTER CT
06250-1683
US

IV. Provider business mailing address

189 STORRS RD
MANSFIELD CENTER CT
06250-1683
US

V. Phone/Fax

Practice location:
  • Phone: 860-696-9874
  • Fax:
Mailing address:
  • Phone: 860-696-9874
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPCT.0015944
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: