Provider Demographics
NPI:1962076182
Name:RIVERA, IVONNE MARIE
Entity type:Individual
Prefix:
First Name:IVONNE
Middle Name:MARIE
Last Name:RIVERA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 CALLE MARGINAL
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00959-5857
Mailing Address - Country:US
Mailing Address - Phone:787-785-0411
Mailing Address - Fax:787-785-0488
Practice Address - Street 1:600 CALLE MARGINAL
Practice Address - Street 2:
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959-5857
Practice Address - Country:US
Practice Address - Phone:787-785-0411
Practice Address - Fax:787-785-0488
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-13
Last Update Date:2021-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7584183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
7584OtherPHARMACY