Provider Demographics
NPI:1992066427
Name:RIVARD, KEVIN (RPH)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:
Last Name:RIVARD
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:P.O. BOX 413
Mailing Address - Street 2:350 BOWMAN ROAD
Mailing Address - City:SPRINGFIELD
Mailing Address - State:NH
Mailing Address - Zip Code:03284
Mailing Address - Country:US
Mailing Address - Phone:603-863-5766
Mailing Address - Fax:603-863-1120
Practice Address - Street 1:51 S MAIN ST
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:NH
Practice Address - Zip Code:03773-1810
Practice Address - Country:US
Practice Address - Phone:603-863-5766
Practice Address - Fax:603-863-1120
Is Sole Proprietor?:No
Enumeration Date:2012-05-31
Last Update Date:2012-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH3253183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist