Provider Demographics
NPI:1356785711
Name:RIVAS, NANNETTE SUE (RPH)
Entity type:Individual
Prefix:
First Name:NANNETTE
Middle Name:SUE
Last Name:RIVAS
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 1:17398 E ASBURY CIR
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80013-1234
Mailing Address - Country:US
Mailing Address - Phone:303-571-1943
Mailing Address - Fax:303-899-5888
Practice Address - Street 1:1331 SPEER BLVD
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80204-2512
Practice Address - Country:US
Practice Address - Phone:303-571-1943
Practice Address - Fax:303-899-5888
Is Sole Proprietor?:No
Enumeration Date:2013-04-29
Last Update Date:2013-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO161731835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO03479003Medicaid
CO0238530094Medicare NSC