Provider Demographics
NPI:1710582655
Name:RIVERA, JUAN ALEJANDRO JR
Entity Type:Individual
Prefix:MR
First Name:JUAN
Middle Name:ALEJANDRO
Last Name:RIVERA
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 N PARROTT AVE
Mailing Address - Street 2:
Mailing Address - City:OKEECHOBEE
Mailing Address - State:FL
Mailing Address - Zip Code:34972-2918
Mailing Address - Country:US
Mailing Address - Phone:863-763-3169
Mailing Address - Fax:863-763-1954
Practice Address - Street 1:106 N PARROTT AVE
Practice Address - Street 2:
Practice Address - City:OKEECHOBEE
Practice Address - State:FL
Practice Address - Zip Code:34972-2918
Practice Address - Country:US
Practice Address - Phone:863-763-3169
Practice Address - Fax:863-763-1954
Is Sole Proprietor?:No
Enumeration Date:2020-11-30
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS33271183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist