Provider Demographics
NPI:1649708769
Name:RIVERA HERNANDEZ, JENNIFER NAHIR (PHARMD)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:NAHIR
Last Name:RIVERA HERNANDEZ
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 1:904 CALLE 31 SO
Mailing Address - Street 2:URB LAS LOMAS
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00921
Mailing Address - Country:US
Mailing Address - Phone:787-792-3196
Mailing Address - Fax:787-781-9220
Practice Address - Street 1:CALLE 31 SO #904
Practice Address - Street 2:URB.. LAS LOMAS
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00921
Practice Address - Country:US
Practice Address - Phone:787-792-3196
Practice Address - Fax:787-781-9220
Is Sole Proprietor?:No
Enumeration Date:2017-06-02
Last Update Date:2017-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6448183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR6448OtherPHARMACY LICENSE NUMBER