Provider Demographics
NPI:1396284543
Name:RIVERA, PEDRO (RPH)
Entity type:Individual
Prefix:
First Name:PEDRO
Middle Name:
Last Name:RIVERA
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:553 SUNLIGHT URB. SUMMIT HILLS
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PUERTO RICO
Mailing Address - Zip Code:00920
Mailing Address - Country:UM
Mailing Address - Phone:787-969-1586
Mailing Address - Fax:787-755-5983
Practice Address - Street 1:CENTRO COMERCIAL LITHEDA
Practice Address - Street 2:CARR. 845 CUPEY BAJO
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00920
Practice Address - Country:US
Practice Address - Phone:787-376-9757
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-21
Last Update Date:2019-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4174183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist