Provider Demographics
NPI:1659676450
Name:RIVERA, MICHELE DEMARCO (PHARMD)
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:DEMARCO
Last Name:RIVERA
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:MICHELE
Other - Middle Name:DAWN
Other - Last Name:GETTENS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:765 ROCK HOUSE RD.
Mailing Address - Street 2:
Mailing Address - City:WALESKA
Mailing Address - State:GA
Mailing Address - Zip Code:30183
Mailing Address - Country:US
Mailing Address - Phone:919-633-8705
Mailing Address - Fax:
Practice Address - Street 1:3760 SIXES RD
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30114-8192
Practice Address - Country:US
Practice Address - Phone:770-345-8378
Practice Address - Fax:770-882-0160
Is Sole Proprietor?:No
Enumeration Date:2011-01-26
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH027407183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist