Provider Demographics
NPI:1518147198
Name:PEREZ, EUFROCINA PEREZ (RPH)
Entity Type:Individual
Prefix:
First Name:EUFROCINA
Middle Name:PEREZ
Last Name: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 1:81 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-9429
Mailing Address - Country:US
Mailing Address - Phone:212-388-9348
Mailing Address - Fax:212-673-3640
Practice Address - Street 1:81 1ST AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-9429
Practice Address - Country:US
Practice Address - Phone:212-388-9348
Practice Address - Fax:212-673-3640
Is Sole Proprietor?:No
Enumeration Date:2007-11-12
Last Update Date:2007-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY044757183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01625938Medicaid