Provider Demographics
NPI:1760025993
Name:RIVERA, TANNIA (PHARMD)
Entity Type:Individual
Prefix:
First Name:TANNIA
Middle Name:
Last Name:RIVERA
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57 CALLE PRINCIPAL
Mailing Address - Street 2:
Mailing Address - City:BARRANQUITAS
Mailing Address - State:PR
Mailing Address - Zip Code:00794-1631
Mailing Address - Country:US
Mailing Address - Phone:787-306-1829
Mailing Address - Fax:
Practice Address - Street 1:57 CALLE PRINCIPAL
Practice Address - Street 2:
Practice Address - City:BARRANQUITAS
Practice Address - State:PR
Practice Address - Zip Code:00794-1631
Practice Address - Country:US
Practice Address - Phone:787-857-0775
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-21
Last Update Date:2019-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5371183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist