Provider Demographics
NPI:1679184659
Name:DAMIANI-RIVERA, ANDRES (RPH)
Entity Type:Individual
Prefix:
First Name:ANDRES
Middle Name:
Last Name:DAMIANI-RIVERA
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 URB LA SERRANIA
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00725-1801
Mailing Address - Country:US
Mailing Address - Phone:787-467-3497
Mailing Address - Fax:
Practice Address - Street 1:47 CALLE RUIZ BELVIS
Practice Address - Street 2:
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725-3510
Practice Address - Country:US
Practice Address - Phone:787-467-3497
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-12
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4677183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR30700022OtherEMPLOYEE NUMBER