Provider Demographics
NPI:1922130814
Name:ANTONIO RIVERA FERNANDEZ
Entity Type:Organization
Organization Name:ANTONIO RIVERA FERNANDEZ
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANTONIO
Authorized Official - Middle Name:
Authorized Official - Last Name:RIVERA FERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-383-2151
Mailing Address - Street 1:53 JOSE DE DIEGO
Mailing Address - Street 2:
Mailing Address - City:CIDRA
Mailing Address - State:PR
Mailing Address - Zip Code:00739-3360
Mailing Address - Country:US
Mailing Address - Phone:787-739-2151
Mailing Address - Fax:787-739-4151
Practice Address - Street 1:53 CALLE JOSE DE DIEGO
Practice Address - Street 2:FARMACIA DEL CARMEN
Practice Address - City:CIDRA
Practice Address - State:PR
Practice Address - Zip Code:00739-3360
Practice Address - Country:US
Practice Address - Phone:787-739-2151
Practice Address - Fax:787-739-4151
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FARMACIA DEL CARMEN
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-09
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR09-F-03813336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy