Individual
SELENA DE LA RIVA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
TECHNICIAN
Contact information
Practice address
1600 W ROOSEVELT RD, BROADVIEW, IL 60155-4024
(708) 343-5323
Mailing address
1600 W ROOSEVELT RD, BROADVIEW, IL 60155-4024
(708) 343-5323
Taxonomy
Speciality
Code
Description
License number
State
183700000X
Pharmacy Technician
Primary
049279949
IL
Other
Enumeration date
03/09/2021
Last updated
03/09/2021
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