Provider Demographics
NPI:1114047297
Name:RIVERA COLON, NOEMI (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:NOEMI
Middle Name:
Last Name:RIVERA COLON
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2Q1 CALLE 17
Mailing Address - Street 2:MIRADOR DE BAIROA
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00727-1006
Mailing Address - Country:US
Mailing Address - Phone:787-743-0601
Mailing Address - Fax:787-737-1242
Practice Address - Street 1:CARRETERA 941
Practice Address - Street 2:SALIDA BARRIO JAGUAS
Practice Address - City:GURABO
Practice Address - State:PR
Practice Address - Zip Code:00778
Practice Address - Country:US
Practice Address - Phone:787-737-4449
Practice Address - Fax:787-737-1242
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2482183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR2482OtherPHARMACY LICENCE