Provider Demographics
NPI:1023393824
Name:LARIVIERE, NICHOLAS RONALD (PHARM D)
Entity type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:RONALD
Last Name:LARIVIERE
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 DERBY AVE
Mailing Address - Street 2:
Mailing Address - City:WEST HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06516-1000
Mailing Address - Country:US
Mailing Address - Phone:833-487-9644
Mailing Address - Fax:203-867-5593
Practice Address - Street 1:600 DERBY AVE
Practice Address - Street 2:
Practice Address - City:WEST HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06516-1000
Practice Address - Country:US
Practice Address - Phone:833-487-9644
Practice Address - Fax:203-867-5593
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-13
Last Update Date:2024-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTPCT.0010150183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist