MEDICARE: JAMIE LEE RIVERA ROBLES PHARMD

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	6537	PR

General Provider Information

NPI Number	:	1831748946
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMIE LEE RIVERA ROBLES PHARMD

Provider Business Mailing Address
First Line	:	1441 AVENIDA FRANKLIN DELANO ROOSEVELT
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00920
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1441 AVE FRANKLIN DELANO ROOSEVELT
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00920-0000
Country	:	US
Telephone Number	:	787-749-4949
Fax Number	:

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

Provider Enumeration Date	:	09/11/2019
Last Update Date	:	12/26/2019

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