Provider Demographics
NPI:1285992792
Name:RIVIERE, MAXINE M (RPH)
Entity type:Individual
Prefix:
First Name:MAXINE
Middle Name:M
Last Name:RIVIERE
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:PO BOX 378
Mailing Address - Street 2:
Mailing Address - City:MOREAUVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71355-0378
Mailing Address - Country:US
Mailing Address - Phone:318-985-2998
Mailing Address - Fax:
Practice Address - Street 1:116 JJJ LN
Practice Address - Street 2:
Practice Address - City:SIMMESPORT
Practice Address - State:LA
Practice Address - Zip Code:71369-2180
Practice Address - Country:US
Practice Address - Phone:318-941-2296
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-03
Last Update Date:2012-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA15201183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist