=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003410366
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | HECTOR ASBEL RIVERA PHARMD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/27/2020
-----------------------------------------------------
Last Update Date | 11/27/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6780 SW 40TH ST
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33155-3753
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-667-1119
-----------------------------------------------------
Fax | 305-667-8450
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8395 SW 73RD AVE APT 425
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33143-7528
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 754-244-1641
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | PS54598
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------