Provider Demographics
NPI:1134851561
Name:DE LA RIVA, LORRAINE ELIZABETH (PHARM D)
Entity type:Individual
Prefix:
First Name:LORRAINE
Middle Name:ELIZABETH
Last Name:DE LA RIVA
Suffix:
Gender:F
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 1:255 LANCASTER DR NE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-5155
Mailing Address - Country:US
Mailing Address - Phone:503-576-8340
Mailing Address - Fax:503-576-8340
Practice Address - Street 1:1175 MOUNT HOOD AVE
Practice Address - Street 2:
Practice Address - City:WOODBURN
Practice Address - State:OR
Practice Address - Zip Code:97071-9060
Practice Address - Country:US
Practice Address - Phone:503-982-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-24
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPI-0012990183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist