Provider Demographics
NPI:1346837259
Name:PERERA, ROBERTO III (PHARMD)
Entity Type:Individual
Prefix:MR
First Name:ROBERTO
Middle Name:
Last Name:PERERA
Suffix:III
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5715 MAGNOLIA RIDGE PL
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34243-4940
Mailing Address - Country:US
Mailing Address - Phone:239-470-8587
Mailing Address - Fax:
Practice Address - Street 1:9856 W PEORIA AVE
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85345-6110
Practice Address - Country:US
Practice Address - Phone:623-977-8260
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-26
Last Update Date:2020-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS021624183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist