Provider Demographics
NPI:1275129280
Name:PEREZ DURAN, LOURDES (RPH)
Entity Type:Individual
Prefix:
First Name:LOURDES
Middle Name:
Last Name:PEREZ DURAN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 SOMERSET WAY
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33326-2980
Mailing Address - Country:US
Mailing Address - Phone:954-778-3481
Mailing Address - Fax:
Practice Address - Street 1:3141 W 76TH ST
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33018-3885
Practice Address - Country:US
Practice Address - Phone:305-231-8200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-14
Last Update Date:2020-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS31333183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist