Provider Demographics
NPI:1548938384
Name:RIVERA-REYES, MARIANGELIZ
Entity type:Individual
Prefix:
First Name:MARIANGELIZ
Middle Name:
Last Name:RIVERA-REYES
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 1:8095 SANDPIPER CIR APT 515
Mailing Address - Street 2:
Mailing Address - City:NOTTINGHAM
Mailing Address - State:MD
Mailing Address - Zip Code:21236-5063
Mailing Address - Country:US
Mailing Address - Phone:443-538-9054
Mailing Address - Fax:
Practice Address - Street 1:401 COMPASS RD
Practice Address - Street 2:
Practice Address - City:MIDDLE RIVER
Practice Address - State:MD
Practice Address - Zip Code:21220-3509
Practice Address - Country:US
Practice Address - Phone:410-780-4770
Practice Address - Fax:443-780-9254
Is Sole Proprietor?:No
Enumeration Date:2021-09-04
Last Update Date:2021-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD28212183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist