Provider Demographics
NPI:1861613754
Name:RIVERA, NESTOR LUIS (RPH)
Entity type:Individual
Prefix:
First Name:NESTOR
Middle Name:LUIS
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 1:470 PRESTWICK PL
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34759-4021
Mailing Address - Country:US
Mailing Address - Phone:407-346-3953
Mailing Address - Fax:
Practice Address - Street 1:1532 W VINE ST
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-4002
Practice Address - Country:US
Practice Address - Phone:407-847-8337
Practice Address - Fax:407-847-0252
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS0032742183500000X
ND5058183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist