MEDICARE: DEYANIRA RIVAS RPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	348873-1701	UT

General Provider Information

NPI Number	:	1316108632
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEYANIRA RIVAS RPH

Provider Business Mailing Address
First Line	:	PO BOX 17685
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84117-0685
Country	:	US
Telephone Number	:	801-355-5257
Fax Number	:	801-363-6731

Provider Business Practice Location Address
First Line	:	876 E 800 S
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84102-3634
Country	:	US
Telephone Number	:	801-355-5257
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/19/2008
Last Update Date	:	06/19/2008

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