Provider Demographics
NPI:1902016389
Name:RIVERA, NILSA MARILYS (RPH)
Entity Type:Individual
Prefix:
First Name:NILSA
Middle Name:MARILYS
Last Name:RIVERA
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 71 BOX 3278
Mailing Address - Street 2:
Mailing Address - City:NARANJITO
Mailing Address - State:PR
Mailing Address - Zip Code:00719-9714
Mailing Address - Country:US
Mailing Address - Phone:787-458-2235
Mailing Address - Fax:
Practice Address - Street 1:HC 71 BOX 3278
Practice Address - Street 2:
Practice Address - City:NARANJITO
Practice Address - State:PR
Practice Address - Zip Code:00719-9714
Practice Address - Country:US
Practice Address - Phone:787-458-2235
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR004651183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist