Provider Demographics
NPI:1255454559
Name:RIVERO, ALEXANDER (RPH)
Entity type:Individual
Prefix:MR
First Name:ALEXANDER
Middle Name:
Last Name:RIVERO
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 GRAND COVE WAY
Mailing Address - Street 2:
Mailing Address - City:EDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:07020-7222
Mailing Address - Country:US
Mailing Address - Phone:201-394-8407
Mailing Address - Fax:973-589-4528
Practice Address - Street 1:492 FERRY ST.
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07105
Practice Address - Country:US
Practice Address - Phone:973-589-6530
Practice Address - Fax:973-589-4528
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02492800183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist