Provider Demographics
NPI:1104361054
Name:PEREZ, ANGELA C (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:C
Last Name:PEREZ
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11503 POTTER ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68142-1511
Mailing Address - Country:US
Mailing Address - Phone:402-573-5373
Mailing Address - Fax:
Practice Address - Street 1:5018 AMES AVE
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68104-2323
Practice Address - Country:US
Practice Address - Phone:402-970-9304
Practice Address - Fax:402-970-9305
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-02
Last Update Date:2017-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE14208183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist