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General NPI Number Information
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NPI Number | 1356954036
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Entity Type | Individual
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Provider Name | MYRNA LUZ RIVAS
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Gender | Female
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Dates
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Enumeration Date | 08/24/2020
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Last Update Date | 01/23/2025
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Provider Practice Location Address
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Address Line | 7000 CERMAK RD
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City | BERWYN
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State | IL
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Zip | 60402-2112
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Country | US
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Telephone | 708-484-8090
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Fax | 708-879-8191
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Provider Business Mailing Address
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Address Line | 7000 CERMAK RD
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City | BERWYN
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State | IL
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Zip | 60402-2112
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Country | US
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Telephone | 708-484-8090
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Fax | 708-879-8191
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 051.301491
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License Number State | IL
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