Provider Demographics
NPI:1518556299
Name:RIVERA, MARGIE IVETTE (CPHT)
Entity Type:Individual
Prefix:
First Name:MARGIE
Middle Name:IVETTE
Last Name:RIVERA
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 POOLER PKWY
Mailing Address - Street 2:
Mailing Address - City:POOLER
Mailing Address - State:GA
Mailing Address - Zip Code:31322-5171
Mailing Address - Country:US
Mailing Address - Phone:912-748-5170
Mailing Address - Fax:
Practice Address - Street 1:500 POOLER PKWY
Practice Address - Street 2:
Practice Address - City:POOLER
Practice Address - State:GA
Practice Address - Zip Code:31322-5171
Practice Address - Country:US
Practice Address - Phone:912-748-5170
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-15
Last Update Date:2021-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPHTC025621183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician