Healthcare Provider Details

I. General information

NPI: 1720982143
Provider Name (Legal Business Name): KATHLEEN RIVERA PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/07/2026
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

94 OLD SHORT HILLS RD
LIVINGSTON NJ
07039-5672
US

IV. Provider business mailing address

5 TIFFANY CT
OLD BRIDGE NJ
08857-3567
US

V. Phone/Fax

Practice location:
  • Phone: 973-322-2826
  • Fax: 973-322-9425
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0200X
TaxonomyPediatric Pharmacist
License Number28RI04329600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: