Provider Demographics
NPI:1841585197
Name:MAISONET RIVERA, PEDRO J (RPH)
Entity type:Individual
Prefix:MR
First Name:PEDRO
Middle Name:J
Last Name:MAISONET RIVERA
Suffix:
Gender:M
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:HC 3 BOX 30402
Mailing Address - Street 2:
Mailing Address - City:AGUADILLA
Mailing Address - State:PR
Mailing Address - Zip Code:00603-9197
Mailing Address - Country:US
Mailing Address - Phone:787-432-1645
Mailing Address - Fax:
Practice Address - Street 1:CARR 2 KM 119.5 BO CAIMITAL ALTO
Practice Address - Street 2:
Practice Address - City:AGUADILLA
Practice Address - State:PR
Practice Address - Zip Code:00603-9197
Practice Address - Country:US
Practice Address - Phone:787-432-1645
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-15
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5041183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist