Healthcare Provider Details

I. General information

NPI: 1932022159
Provider Name (Legal Business Name): KEVIN MANUEL RIVERA CUADRADO PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12639 W ASHCREEK ST APT 102
BOISE ID
83713-1738
US

IV. Provider business mailing address

12639 W ASHCREEK ST APT 102
BOISE ID
83713-1738
US

V. Phone/Fax

Practice location:
  • Phone: 787-980-6215
  • Fax:
Mailing address:
  • Phone: 787-980-6215
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number8710
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number2381434
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: