Provider Demographics
NPI:1669072187
Name:RIVERS, BRIANNE (PHARM D)
Entity type:Individual
Prefix:
First Name:BRIANNE
Middle Name:
Last Name:RIVERS
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 1:3503 ALBATROSS AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65202-3911
Mailing Address - Country:US
Mailing Address - Phone:314-437-3584
Mailing Address - Fax:
Practice Address - Street 1:4820 S CLARK ST
Practice Address - Street 2:
Practice Address - City:MEXICO
Practice Address - State:MO
Practice Address - Zip Code:65265-4111
Practice Address - Country:US
Practice Address - Phone:573-581-2600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-26
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2017029243183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist