Provider Demographics
NPI:1275774663
Name:RIVERA, IRIS ANNETTE (260101030759128)
Entity Type:Individual
Prefix:
First Name:IRIS
Middle Name:ANNETTE
Last Name:RIVERA
Suffix:
Gender:F
Credentials:260101030759128
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR 4 BOX 616N
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00956-9633
Mailing Address - Country:US
Mailing Address - Phone:787-675-3381
Mailing Address - Fax:
Practice Address - Street 1:RR 4 BOX 616N
Practice Address - Street 2:
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00956-9633
Practice Address - Country:US
Practice Address - Phone:787-675-3381
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-13
Last Update Date:2009-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ260101030759128183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician