Provider Demographics
NPI:1699808618
Name:CALEB NEIRA RIVERA
Entity Type:Organization
Organization Name:CALEB NEIRA RIVERA
Other - Org Name:FARMACIA ARCHILLA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-268-6233
Mailing Address - Street 1:PO BOX 14037
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00916-4037
Mailing Address - Country:US
Mailing Address - Phone:787-268-6233
Mailing Address - Fax:787-727-6441
Practice Address - Street 1:387 CALLE BUENAVENTURA
Practice Address - Street 2:ESQ. EDUARDO CONDE
Practice Address - City:SANTURCE
Practice Address - State:PR
Practice Address - Zip Code:00915-2325
Practice Address - Country:US
Practice Address - Phone:787-268-6233
Practice Address - Fax:787-727-6441
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR07-F-10373336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR07-F-1037OtherLIC. NUMBER
PRBC6189181OtherDEA
PR0620480004Medicare ID - Type Unspecified