Provider Demographics
NPI:1477768810
Name:PERERA-MONTANES, OSCAR (RPH, MBA)
Entity Type:Individual
Prefix:MR
First Name:OSCAR
Middle Name:
Last Name:PERERA-MONTANES
Suffix:
Gender:M
Credentials:RPH, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:480 NW FETTERBUSH WAY
Mailing Address - Street 2:
Mailing Address - City:JENSEN BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:34957-3534
Mailing Address - Country:US
Mailing Address - Phone:772-692-5661
Mailing Address - Fax:
Practice Address - Street 1:USPHS-FDIH, CORNER OF N7 AND N12
Practice Address - Street 2:
Practice Address - City:FORT DEFIANCE
Practice Address - State:AZ
Practice Address - Zip Code:86504-0649
Practice Address - Country:US
Practice Address - Phone:928-729-8328
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS19526183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist