Provider Demographics
NPI:1386966612
Name:GAUTIER-RIVERA, GRETEL MARIE (RPH)
Entity type:Individual
Prefix:
First Name:GRETEL
Middle Name:MARIE
Last Name:GAUTIER-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 1:118 FAIRVIEW DR S
Mailing Address - Street 2:
Mailing Address - City:BASKING RIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07920-2328
Mailing Address - Country:US
Mailing Address - Phone:908-766-2071
Mailing Address - Fax:
Practice Address - Street 1:18 W BLACKWELL ST
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:NJ
Practice Address - Zip Code:07801-3841
Practice Address - Country:US
Practice Address - Phone:973-328-9100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-01
Last Update Date:2025-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4016183500000X
NJ28RI03296200183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist