Provider Demographics
NPI:1265067441
Name:RIVERA, TAYLOR ASHLEY (PHARMD)
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:ASHLEY
Last Name:RIVERA
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3900 N 124TH ST
Mailing Address - Street 2:
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53222-2105
Mailing Address - Country:US
Mailing Address - Phone:414-847-1101
Mailing Address - Fax:414-847-1111
Practice Address - Street 1:3900 N 124TH ST
Practice Address - Street 2:
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53222-2105
Practice Address - Country:US
Practice Address - Phone:414-847-1101
Practice Address - Fax:414-847-1111
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-07
Last Update Date:2020-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI19129-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist