Provider Demographics
NPI:1689746182
Name:RIVERA, LUZZETTE Z (RPH)
Entity type:Individual
Prefix:
First Name:LUZZETTE
Middle Name:Z
Last Name:RIVERA
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36205 US HWY 27 N
Mailing Address - Street 2:
Mailing Address - City:HAINES CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33844-3744
Mailing Address - Country:US
Mailing Address - Phone:863-422-7582
Mailing Address - Fax:863-422-7583
Practice Address - Street 1:36205 US HWY 27 N
Practice Address - Street 2:
Practice Address - City:HAINES CITY
Practice Address - State:FL
Practice Address - Zip Code:33844-3744
Practice Address - Country:US
Practice Address - Phone:863-422-7582
Practice Address - Fax:863-422-7583
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2025-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS39298183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0556050966Medicare ID - Type Unspecified