MEDICARE: DR. MERLYN IVETTE RIVERA RIVERA PHARM.D

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	1835P1200X	Pharmacotherapy Pharmacist	5302039095	MI

General Provider Information

NPI Number	:	1699027813
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MERLYN IVETTE RIVERA RIVERA PHARM.D

Provider Business Mailing Address
First Line	:	4624 JESSICA WAY
Second Line	:
City	:	WINDSOR
State	:	ONTARIO
Zip	:	N9G2S4
Country	:	CA
Telephone Number	:	519-250-1142
Fax Number	:

Provider Business Practice Location Address
First Line	:	3669 W MAPLE RD
Second Line	:
City	:	BLOOMFIELD HILLS
State	:	MI
Zip	:	48301-3376
Country	:	US
Telephone Number	:	248-647-4900
Fax Number	:

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

Provider Enumeration Date	:	10/11/2012
Last Update Date	:	10/11/2012

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