Provider Demographics
NPI:1366711863
Name:RIVERA, GLENDA (CPHT)
Entity type:Individual
Prefix:
First Name:GLENDA
Middle Name:
Last Name:RIVERA
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N49 CALLE GLADIOLA
Mailing Address - Street 2:JARDINES DE BORINQUEN
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00985-4232
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:N49 CALLE GLADIOLA
Practice Address - Street 2:JARDINES DE BORINQUEN
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00985-4232
Practice Address - Country:US
Practice Address - Phone:787-944-0304
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-29
Last Update Date:2011-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2723183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician