Provider Demographics
NPI:1194800110
Name:RIVERA, SONIA LISSETTE (PHARMD)
Entity type:Individual
Prefix:
First Name:SONIA
Middle Name:LISSETTE
Last Name:RIVERA
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5755 NW 115 CT
Mailing Address - Street 2:#102
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33178
Mailing Address - Country:US
Mailing Address - Phone:954-804-8753
Mailing Address - Fax:786-336-0736
Practice Address - Street 1:15450 NW 77 COURT
Practice Address - Street 2:WINN DIXIE PHARMACY #262
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33014
Practice Address - Country:US
Practice Address - Phone:305-558-6071
Practice Address - Fax:305-558-6728
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS0036847183500000X
PR5047183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
0556050937Medicare ID - Type Unspecified