Provider Demographics
NPI:1790455640
Name:RIVERA, ROBERT MARTIN
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:MARTIN
Last Name:RIVERA
Suffix:
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 1:342 E FORMOSA BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78221-2911
Mailing Address - Country:US
Mailing Address - Phone:210-818-1802
Mailing Address - Fax:
Practice Address - Street 1:6818 S ZARZAMORA ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78224-1136
Practice Address - Country:US
Practice Address - Phone:210-977-8924
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-14
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician