Provider Demographics
NPI:1467761536
Name:PEREZ, MISTY DAWN (PHARM D)
Entity Type:Individual
Prefix:
First Name:MISTY
Middle Name:DAWN
Last Name:PEREZ
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1909 W BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75426-2010
Mailing Address - Country:US
Mailing Address - Phone:903-427-2050
Mailing Address - Fax:903-427-2098
Practice Address - Street 1:1909 W BROADWAY ST
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TX
Practice Address - Zip Code:75426-2010
Practice Address - Country:US
Practice Address - Phone:903-427-2050
Practice Address - Fax:903-427-2098
Is Sole Proprietor?:No
Enumeration Date:2010-10-06
Last Update Date:2010-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX47819183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist