Provider Demographics
NPI:1962534388
Name:RIVERA, LUZ ANGELES (RPH)
Entity type:Individual
Prefix:MS
First Name:LUZ
Middle Name:ANGELES
Last Name:RIVERA
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 SUMAC ST
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49445-2539
Mailing Address - Country:US
Mailing Address - Phone:231-744-3179
Mailing Address - Fax:
Practice Address - Street 1:4525 WEAVER PKWY
Practice Address - Street 2:SUITE 310
Practice Address - City:WARRENVILLE
Practice Address - State:IL
Practice Address - Zip Code:60555-0318
Practice Address - Country:US
Practice Address - Phone:800-223-9230
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302030765183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist