Provider Demographics
NPI:1841734571
Name:RIVERA, DAISY ELIDIA (PHARMD)
Entity Type:Individual
Prefix:
First Name:DAISY
Middle Name:ELIDIA
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 1:925 WHIMBREL WAY
Mailing Address - Street 2:
Mailing Address - City:PERRIS
Mailing Address - State:CA
Mailing Address - Zip Code:92571-7715
Mailing Address - Country:US
Mailing Address - Phone:951-345-8001
Mailing Address - Fax:
Practice Address - Street 1:925 WHIMBREL WAY
Practice Address - Street 2:
Practice Address - City:PERRIS
Practice Address - State:CA
Practice Address - Zip Code:92571-7715
Practice Address - Country:US
Practice Address - Phone:951-345-8001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-14
Last Update Date:2016-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH75202183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist