Provider Demographics
NPI:1902184120
Name:CRUZ RIVERA, DENISSE (PHARMD)
Entity Type:Individual
Prefix:MRS
First Name:DENISSE
Middle Name:
Last Name:CRUZ 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:J6 CALLE 26
Mailing Address - Street 2:ROYAL TOWN
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00956-4552
Mailing Address - Country:US
Mailing Address - Phone:787-638-0833
Mailing Address - Fax:
Practice Address - Street 1:J6 CALLE 26
Practice Address - Street 2:ROYAL TOWN
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00956-4552
Practice Address - Country:US
Practice Address - Phone:787-638-0833
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-22
Last Update Date:2011-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5449183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR5449OtherLICENCE