Provider Demographics
NPI:1275826158
Name:PEREZ-GRANA, PEDRO A I
Entity Type:Individual
Prefix:MR
First Name:PEDRO
Middle Name:A
Last Name:PEREZ-GRANA
Suffix:I
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:ROAD 180 KM 0.6
Mailing Address - Street 2:
Mailing Address - City:SALINAS
Mailing Address - State:PR
Mailing Address - Zip Code:00745
Mailing Address - Country:US
Mailing Address - Phone:787-824-5408
Mailing Address - Fax:787-824-1545
Practice Address - Street 1:500 AVE PEDRO ALBIZU CAMPOS # SALINAS
Practice Address - Street 2:CARR 180 KM 0.6
Practice Address - City:SALINAS
Practice Address - State:PR
Practice Address - Zip Code:00751-3213
Practice Address - Country:US
Practice Address - Phone:787-824-5408
Practice Address - Fax:787-824-1545
Is Sole Proprietor?:No
Enumeration Date:2011-05-25
Last Update Date:2011-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3642183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist