Provider Demographics
NPI:1164044525
Name:RIVERA, MICHAEL (PHARMD, BCPS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:RIVERA
Suffix:
Gender:M
Credentials:PHARMD, BCPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12126 CHAPEL HILL RD
Mailing Address - Street 2:
Mailing Address - City:HORIZON CITY
Mailing Address - State:TX
Mailing Address - Zip Code:79928-2117
Mailing Address - Country:US
Mailing Address - Phone:915-526-5049
Mailing Address - Fax:
Practice Address - Street 1:2001 N OREGON ST
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-3320
Practice Address - Country:US
Practice Address - Phone:915-577-6731
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-08
Last Update Date:2020-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX550201835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy