=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023393824
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NICHOLAS RONALD LARIVIERE PHARM. D
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/13/2011
-----------------------------------------------------
Last Update Date | 09/20/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 600 DERBY AVE
-----------------------------------------------------
City | WEST HAVEN
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06516-1000
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 833-487-9644
-----------------------------------------------------
Fax | 203-867-5593
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 600 DERBY AVE
-----------------------------------------------------
City | WEST HAVEN
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06516-1000
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 833-487-9644
-----------------------------------------------------
Fax | 203-867-5593
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | PCT.0010150
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------