=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710555677
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANDREA ORTIZ RIVERA PHARMD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/16/2021
-----------------------------------------------------
Last Update Date | 06/16/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10201 W INNOVATION DR STE 600
-----------------------------------------------------
City | MILWAUKEE
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53226-4830
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 414-410-8152
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2956 W STATESMAN WAY APT 308
-----------------------------------------------------
City | FRANKLIN
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53132-4811
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-817-9525
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 19140
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------