Provider Demographics
NPI:1871075606
Name:GONZALEZ RIVERA, BRYAN LOUIS (PHARMD)
Entity type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:LOUIS
Last Name:GONZALEZ RIVERA
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 57 BOX 10703
Mailing Address - Street 2:
Mailing Address - City:AGUADA
Mailing Address - State:PR
Mailing Address - Zip Code:00602-9830
Mailing Address - Country:US
Mailing Address - Phone:787-548-2678
Mailing Address - Fax:
Practice Address - Street 1:CVS PHARMACY 1901 CALLE HAYDEE REXACH BOSANTURCE
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918
Practice Address - Country:US
Practice Address - Phone:787-727-7770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-29
Last Update Date:2018-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6535183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty