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General NPI Number Information
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NPI Number | 1598634917
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Entity Type | Individual
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Provider Name | STACEY M RIVERA PHARMD
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Gender | Female
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Dates
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Enumeration Date | 11/03/2025
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Last Update Date | 11/03/2025
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Provider Practice Location Address
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Address Line | 1115 SE 164TH AVE
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City | VANCOUVER
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State | WA
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Zip | 98683-9324
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Country | US
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Telephone | 503-367-0402
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Fax |
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Provider Business Mailing Address
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Address Line | 19730 SPRING RIDGE DR
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City | WEST LINN
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State | OR
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Zip | 97068-4821
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Country | US
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Telephone |
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Fax |
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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 | 10838
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License Number State | OR
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