Healthcare Provider Details

I. General information

NPI: 1073969432
Provider Name (Legal Business Name): GLORIA RIVERS CPHT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2016
Last Update Date: 05/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1661 EIDER DOWN DR.
SUMMERVILLE SC
29415
US

IV. Provider business mailing address

PO BOX 72373
NORTH CHARLESTON SC
29415-2373
US

V. Phone/Fax

Practice location:
  • Phone: 843-695-7295
  • Fax:
Mailing address:
  • Phone: 843-695-7295
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number360101060761960
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number21674
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: