Provider Demographics
NPI:1164545067
Name:PEREZ, CORALY (PHARMD)
Entity Type:Individual
Prefix:MISS
First Name:CORALY
Middle Name:
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:PO BOX 1946
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00726-1946
Mailing Address - Country:US
Mailing Address - Phone:787-685-9326
Mailing Address - Fax:787-783-2951
Practice Address - Street 1:1210 AVE AMERICO MIRANDA
Practice Address - Street 2:REPARTO METROPOLITANO
Practice Address - City:RIO PIEDRAS
Practice Address - State:PR
Practice Address - Zip Code:00921-1620
Practice Address - Country:US
Practice Address - Phone:787-783-8579
Practice Address - Fax:787-783-2951
Is Sole Proprietor?:No
Enumeration Date:2007-04-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4918183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist