Healthcare Provider Details

I. General information

NPI: 1891259628
Provider Name (Legal Business Name): AARON RIVERA PHARM D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/25/2019
Last Update Date: 01/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10909 ESTRIBO ST NW
ALBUQUERQUE NM
87114-6309
US

IV. Provider business mailing address

10909 ESTRIBO ST NW
ALBUQUERQUE NM
87114-6309
US

V. Phone/Fax

Practice location:
  • Phone: 505-480-1808
  • Fax:
Mailing address:
  • Phone: 505-480-1808
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberNM00008014
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: