Provider Demographics
NPI:1528404027
Name:RIVERS, PERRET ODETTE (RPH)
Entity Type:Individual
Prefix:
First Name:PERRET
Middle Name:ODETTE
Last Name:RIVERS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 HIGHWAY 90 E
Mailing Address - Street 2:
Mailing Address - City:MORGAN CITY
Mailing Address - State:LA
Mailing Address - Zip Code:70380-5158
Mailing Address - Country:US
Mailing Address - Phone:985-395-6181
Mailing Address - Fax:
Practice Address - Street 1:1301 HIGHWAY 90 E
Practice Address - Street 2:
Practice Address - City:MORGAN CITY
Practice Address - State:LA
Practice Address - Zip Code:70380-5158
Practice Address - Country:US
Practice Address - Phone:985-395-6181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-11
Last Update Date:2013-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA14853183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist