Provider Demographics
NPI:1326667759
Name:RIVERA, PABLO JUAN I
Entity Type:Individual
Prefix:
First Name:PABLO
Middle Name:JUAN
Last Name:RIVERA
Suffix:I
Gender:M
Credentials:
Other - Prefix:
Other - First Name:PABLO
Other - Middle Name:J
Other - Last Name:RIVERA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:URB SUNRISE
Mailing Address - Street 2:104 MORNING DEW G-12
Mailing Address - City:HUMACAO
Mailing Address - State:PR
Mailing Address - Zip Code:00791
Mailing Address - Country:US
Mailing Address - Phone:787-218-4656
Mailing Address - Fax:
Practice Address - Street 1:FARMACIAS MARISEL
Practice Address - Street 2:ESQ. ANTONIO LOPEZ
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00971
Practice Address - Country:US
Practice Address - Phone:787-850-9246
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-15
Last Update Date:2020-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4244183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist