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General NPI Number Information
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NPI Number | 1518090422
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Entity Type | Organization
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Legal Business Name | ANTONIO RIVERA FERNANDEZ
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Dates
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Enumeration Date | 03/13/2007
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Last Update Date | 06/18/2008
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Provider Practice Location Address
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Address Line | CARR. #172 KM. 7.6 BO. CERTENEJAS
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City | CIDRA
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State | PR
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Zip | 00739
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Country | US
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Telephone | 787-739-3881
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Fax | 787-739-7666
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Provider Business Mailing Address
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Address Line | 53 CALLE JOSE DE DIEGO
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City | CIDRA
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State | PR
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Zip | 00739-3360
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Country | US
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Telephone | 787-739-3881
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Fax | 787-739-7666
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Authorized Official
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Title or Position | PHARMACIST
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Name | IRMANELL RIVERA
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Credential | RPH
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Telephone | 787-739-3881
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | 09-F1518
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License Number State | PR
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