MEDICARE: MARISEL RIVERA-POLANCO

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	PS40398	FL

General Provider Information

NPI Number	:	1942844584
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARISEL RIVERA-POLANCO

Provider Business Mailing Address
First Line	:	14818 FAVERSHAM CIR
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32826-4106
Country	:	US
Telephone Number	:	407-405-4428
Fax Number	:

Provider Business Practice Location Address
First Line	:	9047 CURRY FORD RD
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32825-7604
Country	:	US
Telephone Number	:	407-845-6530
Fax Number	:	407-845-6529

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

Provider Enumeration Date	:	11/06/2019
Last Update Date	:	11/06/2019

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Directions to “ MARISEL RIVERA-POLANCO ” Practice Location

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