Healthcare Provider Details

I. General information

NPI: 1568745420
Provider Name (Legal Business Name): KATHRYN ANN RIVERA PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2011
Last Update Date: 09/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5764 S LINDBERGH BLVD
SAINT LOUIS MO
63123-6937
US

IV. Provider business mailing address

PO BOX 20102
SAINT LOUIS MO
63123-0302
US

V. Phone/Fax

Practice location:
  • Phone: 314-842-3372
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number2003003292
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: