Healthcare Provider Details

I. General information

NPI: 1629606520
Provider Name (Legal Business Name): KAREN RIVERA CPHT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2020
Last Update Date: 03/28/2020
Certification Date: 03/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6501 LOISDALE CT
SPRINGFIELD VA
22150-1826
US

IV. Provider business mailing address

2624 GLENRIVER WAY
WOODBRIDGE VA
22191-5171
US

V. Phone/Fax

Practice location:
  • Phone: 703-922-1000
  • Fax:
Mailing address:
  • Phone: 703-901-8147
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License NumberPT01487
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License NumberT23469
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number0230017488
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: