Provider Demographics
NPI:1225462443
Name:PEROVICH, VIRGINIA MARIE (PHARMD)
Entity Type:Individual
Prefix:MRS
First Name:VIRGINIA
Middle Name:MARIE
Last Name:PEROVICH
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 1:7615 ETIWANDA AVE UNIT 277
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91739-7011
Mailing Address - Country:US
Mailing Address - Phone:562-882-2828
Mailing Address - Fax:
Practice Address - Street 1:137 N. HARVARD AVE.
Practice Address - Street 2:
Practice Address - City:CLAREMONT
Practice Address - State:CA
Practice Address - Zip Code:91711-7011
Practice Address - Country:US
Practice Address - Phone:562-882-2828
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-23
Last Update Date:2017-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA693401835P0018X, 183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist