Provider Demographics
NPI:1861514747
Name:RIVERA, TERESITA (RPH)
Entity type:Individual
Prefix:
First Name:TERESITA
Middle Name:
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:PO BOX 1014
Mailing Address - Street 2:
Mailing Address - City:TRUJILLO ALTO
Mailing Address - State:PR
Mailing Address - Zip Code:00977-1014
Mailing Address - Country:US
Mailing Address - Phone:787-748-1417
Mailing Address - Fax:787-769-5353
Practice Address - Street 1:FARMACIA AMIGA DE MONTECARLO CENTRO COMERCIAL LOCAL #1
Practice Address - Street 2:RAFAEL HERNANDEZ MARIN #800 ST. 5
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00924-5288
Practice Address - Country:US
Practice Address - Phone:787-762-1616
Practice Address - Fax:787-769-5353
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3936183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist