Basic Information
| Provider Information | |||||||||
| NPI: | 1629606520 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RIVERA | ||||||||
| FirstName: | KAREN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | CPHT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2624 GLENRIVER WAY | ||||||||
| Address2: | |||||||||
| City: | WOODBRIDGE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 221915171 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7039018147 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 6501 LOISDALE CT | ||||||||
| Address2: | |||||||||
| City: | SPRINGFIELD | ||||||||
| State: | VA | ||||||||
| PostalCode: | 221501826 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7039221000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/28/2020 | ||||||||
| LastUpdateDate: | 03/28/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/28/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183700000X | PT01487 | DC | N | Pharmacy Service Providers | Pharmacy Technician | 183700000X | T23469 | MD | N | Pharmacy Service Providers | Pharmacy Technician | 183700000X | 0230017488 | VA | Y | Pharmacy Service Providers | Pharmacy Technician |
No ID Information.