Provider Demographics
NPI:1417339458
Name:RIVERA, JOEL JOSE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JOEL
Middle Name:JOSE
Last Name:RIVERA
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 MEETING PL
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32814-6602
Mailing Address - Country:US
Mailing Address - Phone:407-897-7373
Mailing Address - Fax:
Practice Address - Street 1:1501 MEETING PL
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32814-6602
Practice Address - Country:US
Practice Address - Phone:407-897-7373
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-26
Last Update Date:2015-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS53321183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist