Provider Demographics
NPI:1942690607
Name:RIVERA, CAITLIN FAYE
Entity Type:Individual
Prefix:
First Name:CAITLIN FAYE
Middle Name:
Last Name:RIVERA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1331 WOODSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH BALDWIN
Mailing Address - State:NY
Mailing Address - Zip Code:11510-1938
Mailing Address - Country:US
Mailing Address - Phone:516-972-2522
Mailing Address - Fax:
Practice Address - Street 1:1331 WOODSIDE AVE
Practice Address - Street 2:
Practice Address - City:NORTH BALDWIN
Practice Address - State:NY
Practice Address - Zip Code:11510-1938
Practice Address - Country:US
Practice Address - Phone:516-972-2522
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-02
Last Update Date:2015-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician