Provider Demographics
NPI:1518090422
Name:ANTONIO RIVERA FERNANDEZ
Entity Type:Organization
Organization Name:ANTONIO RIVERA FERNANDEZ
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:IRMANELL
Authorized Official - Middle Name:
Authorized Official - Last Name:RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:787-739-3881
Mailing Address - Street 1:53 CALLE JOSE DE DIEGO
Mailing Address - Street 2:
Mailing Address - City:CIDRA
Mailing Address - State:PR
Mailing Address - Zip Code:00739-3360
Mailing Address - Country:US
Mailing Address - Phone:787-739-3881
Mailing Address - Fax:787-739-7666
Practice Address - Street 1:CARR. #172 KM. 7.6
Practice Address - Street 2:BO. CERTENEJAS
Practice Address - City:CIDRA
Practice Address - State:PR
Practice Address - Zip Code:00739
Practice Address - Country:US
Practice Address - Phone:787-739-3881
Practice Address - Fax:787-739-7666
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FARMA EXPRESO
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-13
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR09-F1518333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy