Healthcare Provider Details

I. General information

NPI: 1164044525
Provider Name (Legal Business Name): MICHAEL RIVERA PHARMD, BCPS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2020
Last Update Date: 05/08/2020
Certification Date: 05/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 N OREGON ST
EL PASO TX
79902-3320
US

IV. Provider business mailing address

12126 CHAPEL HILL RD
HORIZON CITY TX
79928-2117
US

V. Phone/Fax

Practice location:
  • Phone: 915-577-6731
  • Fax:
Mailing address:
  • Phone: 915-526-5049
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number55020
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: