MEDICARE: ETANISLAO RIVERA PHARMACIST

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	3428	PR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3428	OTHER	PR	PHARMACIST LICENSE

General Provider Information

NPI Number	:	1417957853
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ETANISLAO RIVERA PHARMACIST

Provider Business Mailing Address
First Line	:	57 CALLE PRINCIPAL
Second Line	:
City	:	BARRANQUITAS
State	:	PR
Zip	:	00794-1631
Country	:	US
Telephone Number	:	787-857-1775
Fax Number	:	787-857-0775

Provider Business Practice Location Address
First Line	:	57 CALLE PRINCIPAL
Second Line	:
City	:	BARRANQUITAS
State	:	PR
Zip	:	00794-1631
Country	:	US
Telephone Number	:	787-857-1775
Fax Number	:	787-857-0775

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

Provider Enumeration Date	:	07/28/2005
Last Update Date	:	07/08/2007

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Directions to “ ETANISLAO RIVERA PHARMACIST” Practice Location

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