Provider Demographics
NPI:1124680137
Name:RIVERA, IDABEL (RPH)
Entity type:Individual
Prefix:
First Name:IDABEL
Middle Name:
Last Name:RIVERA
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:EL VALLE
Mailing Address - Street 2:277 PASEO DE LA PALMA REAL
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00727-3208
Mailing Address - Country:US
Mailing Address - Phone:787-632-8462
Mailing Address - Fax:787-653-0939
Practice Address - Street 1:DEL RIO SHOPPING CENTER
Practice Address - Street 2:VALLE TOLIMA
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725
Practice Address - Country:US
Practice Address - Phone:787-653-8778
Practice Address - Fax:787-653-8789
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-01
Last Update Date:2019-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4818183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty