Provider Demographics
NPI:1407140072
Name:RIVERA, JOSE H (RPH)
Entity type:Individual
Prefix:MR
First Name:JOSE
Middle Name:H
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 1:1115 65 DE INFANTERIA AVENUE
Mailing Address - Street 2:WALGREENS #363
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00924
Mailing Address - Country:US
Mailing Address - Phone:787-768-4700
Mailing Address - Fax:787-768-5673
Practice Address - Street 1:1115 65 DE INFANTERIA AVENUE
Practice Address - Street 2:WALGREENS #363
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00924
Practice Address - Country:US
Practice Address - Phone:787-768-4700
Practice Address - Fax:787-768-5673
Is Sole Proprietor?:No
Enumeration Date:2011-06-01
Last Update Date:2011-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2915183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist