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General NPI Number Information
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NPI Number | 1659676450
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Entity Type | Individual
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Provider Name | MICHELE DEMARCO RIVERA PHARM.D.
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Gender | Female
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Dates
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Enumeration Date | 01/26/2011
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Last Update Date | 12/03/2024
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Provider Practice Location Address
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Address Line | 3760 SIXES RD
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City | CANTON
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State | GA
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Zip | 30114-8192
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Country | US
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Telephone | 770-345-8378
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Fax | 770-882-0160
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Provider Business Mailing Address
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Address Line | 765 ROCK HOUSE RD.
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City | WALESKA
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State | GA
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Zip | 30183
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Country | US
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Telephone | 919-633-8705
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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 | RPH027407
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License Number State | GA
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