Provider Demographics
NPI:1073969432
Name:RIVERS, GLORIA (CPHT)
Entity Type:Individual
Prefix:MRS
First Name:GLORIA
Middle Name:
Last Name:RIVERS
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 72373
Mailing Address - Street 2:
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29415-2373
Mailing Address - Country:US
Mailing Address - Phone:843-695-7295
Mailing Address - Fax:
Practice Address - Street 1:1661 EIDER DOWN DR.
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29415
Practice Address - Country:US
Practice Address - Phone:843-695-7295
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-04
Last Update Date:2016-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC360101060761960183700000X
SC21674183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician