Provider Demographics
NPI:1154652279
Name:MEDINA-RIVERA, ROBERTO (RPH)
Entity Type:Individual
Prefix:
First Name:ROBERTO
Middle Name:
Last Name:MEDINA-RIVERA
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 1:155 AVE ARTERIAL HOSTOS
Mailing Address - Street 2:GOLDEN COURT II BOX 306 APT. Q-102
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918-2987
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:155 AVE ARTERIAL HOSTOS
Practice Address - Street 2:GOLDEN COURT II BOX 306 APT. Q-102
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-2987
Practice Address - Country:US
Practice Address - Phone:787-765-7373
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-29
Last Update Date:2010-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR004424183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist