Provider Demographics
NPI:1013054527
Name:RIVERA, IRMANELL (RPH)
Entity type:Individual
Prefix:
First Name:IRMANELL
Middle Name:
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:URB. CAMPO LAGO
Mailing Address - Street 2:25 CALLE CAMPO
Mailing Address - City:CIDRA
Mailing Address - State:PR
Mailing Address - Zip Code:00739-9359
Mailing Address - Country:US
Mailing Address - Phone:787-739-3881
Mailing Address - Fax:787-739-7666
Practice Address - Street 1:CARR. # 172 KM. 7.6
Practice Address - Street 2:BO. CERTENEJAS
Practice Address - City:CIDRA
Practice Address - State:PR
Practice Address - Zip Code:00739
Practice Address - Country:US
Practice Address - Phone:787-739-3881
Practice Address - Fax:787-739-7666
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4954183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist