Provider Demographics
NPI:1689746182
Name:RIVERA, LUZZETTE Z (RPH)
Entity Type:Individual
Prefix:
First Name:LUZZETTE
Middle Name:Z
Last Name:RIVERA
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 1:17051 SW 51ST CT
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33027-4924
Mailing Address - Country:US
Mailing Address - Phone:954-821-6447
Mailing Address - Fax:
Practice Address - Street 1:17101 MIRAMAR PKWY
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33027-4565
Practice Address - Country:US
Practice Address - Phone:954-704-9890
Practice Address - Fax:954-704-9082
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS39298183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0556050966Medicare ID - Type Unspecified