Healthcare Provider Details

I. General information

NPI: 1336060409
Provider Name (Legal Business Name): NICHOLAS ALEXANDER RIVERO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2026
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8601 NW 186TH ST
HIALEAH FL
33015-2553
US

IV. Provider business mailing address

8601 NW 186TH ST
HIALEAH FL
33015-2553
US

V. Phone/Fax

Practice location:
  • Phone: 305-829-0423
  • Fax:
Mailing address:
  • Phone: 305-829-0423
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS71033
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: