Healthcare Provider Details

I. General information

NPI: 1891052304
Provider Name (Legal Business Name): NELLY L RIVERA PH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2012
Last Update Date: 04/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR. #3, AVE. 65 DE INFANTERIA, INTERSEC CARR. #887 BO. SAN ANTON
CAROLINA PR
00986-0858
US

IV. Provider business mailing address

J8 CALLE 3 VALPARAISO
TOA BAJA PR
00949-4040
US

V. Phone/Fax

Practice location:
  • Phone: 787-757-6850
  • Fax:
Mailing address:
  • Phone: 787-784-8745
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number2377
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: