Provider Demographics
NPI:1114934593
Name:PEREZ, ENID
Entity Type:Individual
Prefix:MRS
First Name:ENID
Middle Name:
Last Name:PEREZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:243 CALLE PARIS PMB 1016
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00917-3632
Mailing Address - Country:US
Mailing Address - Phone:787-766-1128
Mailing Address - Fax:787-764-4442
Practice Address - Street 1:327 AVE BARBOSA
Practice Address - Street 2:SUPER FARMACIA BARBOSA
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00917-3314
Practice Address - Country:US
Practice Address - Phone:787-763-8477
Practice Address - Fax:787-765-3461
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5035183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician