Provider Demographics
NPI:1376851139
Name:DIAZ-PEREZ, EVELYN (RPH)
Entity Type:Individual
Prefix:MRS
First Name:EVELYN
Middle Name:
Last Name:DIAZ-PEREZ
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 1:113 CALLE PERIDOT
Mailing Address - Street 2:
Mailing Address - City:DORADO
Mailing Address - State:PR
Mailing Address - Zip Code:00646-9658
Mailing Address - Country:US
Mailing Address - Phone:787-598-8247
Mailing Address - Fax:
Practice Address - Street 1:113 CALLE PERIDOT
Practice Address - Street 2:LOS PRADOS SUR
Practice Address - City:DORADO
Practice Address - State:PR
Practice Address - Zip Code:00646-9658
Practice Address - Country:US
Practice Address - Phone:787-598-8247
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-15
Last Update Date:2010-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3222183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist