Provider Demographics
NPI:1669847919
Name:RIVERA, GERARD (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:GERARD
Middle Name:
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 1:351 HOSPITAL RD STE 107
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663-3503
Mailing Address - Country:US
Mailing Address - Phone:949-764-6580
Mailing Address - Fax:949-764-6581
Practice Address - Street 1:351 HOSPITAL RD STE 107
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-3503
Practice Address - Country:US
Practice Address - Phone:949-764-6580
Practice Address - Fax:949-764-6581
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-10
Last Update Date:2015-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA66274183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist