Provider Demographics
NPI:1417153297
Name:PEREDA, IRIS AMPARO (RPH)
Entity Type:Individual
Prefix:
First Name:IRIS
Middle Name:AMPARO
Last Name:PEREDA
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 1:0S711 ROBBINS ST
Mailing Address - Street 2:
Mailing Address - City:WINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60190-1639
Mailing Address - Country:US
Mailing Address - Phone:630-681-8851
Mailing Address - Fax:
Practice Address - Street 1:177 E ROOSEVELT RD
Practice Address - Street 2:
Practice Address - City:WEST CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60185-3966
Practice Address - Country:US
Practice Address - Phone:630-293-5340
Practice Address - Fax:630-293-5380
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist