Provider Demographics
NPI:1083671804
Name:TEODORO RIVERA RIVERA
Entity Type:Organization
Organization Name:TEODORO RIVERA RIVERA
Other - Org Name:FARMACIA SAN FRANCISCO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:TEODORO
Authorized Official - Middle Name:
Authorized Official - Last Name:RIVERA RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-858-2784
Mailing Address - Street 1:CALLE BETANCES
Mailing Address - Street 2:# 4
Mailing Address - City:VEGA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00693
Mailing Address - Country:US
Mailing Address - Phone:787-858-2784
Mailing Address - Fax:
Practice Address - Street 1:CALLE BETANCES
Practice Address - Street 2:# 4
Practice Address - City:VEGA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00693
Practice Address - Country:US
Practice Address - Phone:787-858-2784
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-26
Last Update Date:2008-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2512183500000X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR4662700001Medicare NSC