Provider Demographics
NPI:1740378298
Name:RIVERA, TABATHA Y
Entity type:Individual
Prefix:
First Name:TABATHA
Middle Name:Y
Last Name:RIVERA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 CALLE MONTE NEGRO
Mailing Address - Street 2:URB JARDINES MONTELLANOS
Mailing Address - City:MOROVIS
Mailing Address - State:PR
Mailing Address - Zip Code:00687-2903
Mailing Address - Country:US
Mailing Address - Phone:787-854-2041
Mailing Address - Fax:787-884-9039
Practice Address - Street 1:200 MONACO SHOPPING CENTER - SUITE 1
Practice Address - Street 2:FARMACIA DEL POZO
Practice Address - City:MANATI
Practice Address - State:PR
Practice Address - Zip Code:00674
Practice Address - Country:US
Practice Address - Phone:787-854-2041
Practice Address - Fax:787-884-9039
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5194183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician