Provider Demographics
NPI:1912450800
Name:RIVERA BUITRAGO, SHIRLEY MARLYN (PHARMD)
Entity type:Individual
Prefix:DR
First Name:SHIRLEY
Middle Name:MARLYN
Last Name:RIVERA BUITRAGO
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 1:505 AVE HOSTOS
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00680-1797
Mailing Address - Country:US
Mailing Address - Phone:787-831-0674
Mailing Address - Fax:787-834-2698
Practice Address - Street 1:505 AVE HOSTOS
Practice Address - Street 2:
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680-1797
Practice Address - Country:US
Practice Address - Phone:787-831-0674
Practice Address - Fax:787-834-2698
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-27
Last Update Date:2016-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6352183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist