Provider Demographics
NPI:1699171165
Name:RIVERA, ANA M (PHARMD)
Entity type:Individual
Prefix:
First Name:ANA
Middle Name:M
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 1:31 REDTAIL DR APT 19
Mailing Address - Street 2:
Mailing Address - City:CORALVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:52241-4027
Mailing Address - Country:US
Mailing Address - Phone:939-247-8679
Mailing Address - Fax:
Practice Address - Street 1:555 W CHERRY ST
Practice Address - Street 2:
Practice Address - City:NORTH LIBERTY
Practice Address - State:IA
Practice Address - Zip Code:52317-9797
Practice Address - Country:US
Practice Address - Phone:319-626-6188
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-11
Last Update Date:2014-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA22384183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist