Provider Demographics
NPI:1326682394
Name:BRUNO RIVERA, VALERIE (PHARMD)
Entity Type:Individual
Prefix:
First Name:VALERIE
Middle Name:
Last Name:BRUNO RIVERA
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4005 PINELLA CIR APT 394
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-6726
Mailing Address - Country:US
Mailing Address - Phone:787-643-5190
Mailing Address - Fax:
Practice Address - Street 1:1333 NW SAINT LUCIE WEST BLVD
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34986-2140
Practice Address - Country:US
Practice Address - Phone:772-340-4350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-03
Last Update Date:2019-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS59953183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPS59953OtherFLORIDA BOARD OF PHARMACY