Provider Demographics
NPI:1770189102
Name:RIVERA, JOSE ORLANDO (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:ORLANDO
Last Name:RIVERA
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:JOSE
Other - Middle Name:O
Other - Last Name:RIVERA-ORTIZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1101 N CAMPBELL ST STE 110
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902-4238
Mailing Address - Country:US
Mailing Address - Phone:915-747-8519
Mailing Address - Fax:915-747-8521
Practice Address - Street 1:1101 N CAMPBELL ST STE 110
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-4238
Practice Address - Country:US
Practice Address - Phone:915-747-8519
Practice Address - Fax:915-747-8521
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-10
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX353921835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX35392OtherRPH
TX03097670OtherTDMV