Provider Demographics
NPI:1164571022
Name:RIVERA, JENNY ELISA (RPH)
Entity Type:Individual
Prefix:
First Name:JENNY
Middle Name:ELISA
Last Name:RIVERA
Suffix:
Gender:F
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:J-6 STREET # 1
Mailing Address - Street 2:LOS FRAILES NORTE
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969
Mailing Address - Country:US
Mailing Address - Phone:787-784-3225
Mailing Address - Fax:787-784-4028
Practice Address - Street 1:J-6 ST 1
Practice Address - Street 2:LOS FRAILES NORTE
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00969
Practice Address - Country:US
Practice Address - Phone:787-784-3225
Practice Address - Fax:787-784-4028
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2351183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist