Provider Demographics
NPI:1275136749
Name:RIVAS, STEPHEN
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:
Last Name:RIVAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1187
Mailing Address - Street 2:
Mailing Address - City:MONTAGUE
Mailing Address - State:NJ
Mailing Address - Zip Code:07827-0187
Mailing Address - Country:US
Mailing Address - Phone:210-618-5307
Mailing Address - Fax:
Practice Address - Street 1:220 ROUTE 6 AND 209
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:PA
Practice Address - Zip Code:18337-9454
Practice Address - Country:US
Practice Address - Phone:210-618-5307
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-18
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP450558183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist