Provider Demographics
NPI:1669778130
Name:RIVERA, NANCY AMARGO (PHARM D)
Entity type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:AMARGO
Last Name:RIVERA
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 1:1610 NW LOUISIANA AVE
Mailing Address - Street 2:
Mailing Address - City:CHEHALIS
Mailing Address - State:WA
Mailing Address - Zip Code:98532-1711
Mailing Address - Country:US
Mailing Address - Phone:360-740-1876
Mailing Address - Fax:
Practice Address - Street 1:1610 NW LOUISIANA AVE
Practice Address - Street 2:
Practice Address - City:CHEHALIS
Practice Address - State:WA
Practice Address - Zip Code:98532-1711
Practice Address - Country:US
Practice Address - Phone:360-740-1876
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-01
Last Update Date:2011-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH39083183500000X
CA46272183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist