Provider Demographics
NPI:1538949193
Name:RIVERS, ROXANNE ALEXANDRIA
Entity type:Individual
Prefix:
First Name:ROXANNE
Middle Name:ALEXANDRIA
Last Name:RIVERS
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 1:141 CORNER OAK CT
Mailing Address - Street 2:
Mailing Address - City:WALESKA
Mailing Address - State:GA
Mailing Address - Zip Code:30183-4210
Mailing Address - Country:US
Mailing Address - Phone:470-271-0418
Mailing Address - Fax:
Practice Address - Street 1:141 CORNER OAK CT
Practice Address - Street 2:
Practice Address - City:WALESKA
Practice Address - State:GA
Practice Address - Zip Code:30183-4210
Practice Address - Country:US
Practice Address - Phone:470-271-0418
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-02
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPHTC046054183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician