Provider Demographics
NPI:1669643870
Name:RIVERA, IRIS B (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:IRIS
Middle Name:B
Last Name:RIVERA
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 51063
Mailing Address - Street 2:
Mailing Address - City:TOA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00950-1063
Mailing Address - Country:US
Mailing Address - Phone:787-784-4585
Mailing Address - Fax:787-795-1465
Practice Address - Street 1:AVENIDA BOULEVARD 3385-86
Practice Address - Street 2:LEVITTOWN
Practice Address - City:TOA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00949
Practice Address - Country:US
Practice Address - Phone:787-784-4585
Practice Address - Fax:787-795-1465
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-14
Last Update Date:2008-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2198183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist