MEDICARE: DR. LEONARDO ANTONIO RIVERA 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	S026447	AZ

General Provider Information

NPI Number	:	1992489967
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LEONARDO ANTONIO RIVERA PHARMD

Provider Business Mailing Address
First Line	:	3006 S 81ST LN
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85043-1587
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2626 S 83RD AVE STE A
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85043-0905
Country	:	US
Telephone Number	:	623-907-2472
Fax Number	:	623-907-0548

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

Provider Enumeration Date	:	06/12/2023
Last Update Date	:	06/15/2026

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