Provider Demographics
NPI:1881970473
Name:RIVERA, CHRISTINE MARY (RPH)
Entity type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:MARY
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 1:2838 E SIERRA MADRE BLVD
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91107-1843
Mailing Address - Country:US
Mailing Address - Phone:626-963-3281
Mailing Address - Fax:626-963-5213
Practice Address - Street 1:435 W FOOTHILL BLVD
Practice Address - Street 2:
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91741-3363
Practice Address - Country:US
Practice Address - Phone:626-963-3281
Practice Address - Fax:626-963-5213
Is Sole Proprietor?:No
Enumeration Date:2011-10-26
Last Update Date:2011-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA44894183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA429710Medicaid