Provider Demographics
NPI:1558645101
Name:PEREZ, ANTHONY (RPH)
Entity Type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:
Last Name:PEREZ
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:59 VERBENA AVE
Mailing Address - Street 2:
Mailing Address - City:FLORAL PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11001-2711
Mailing Address - Country:US
Mailing Address - Phone:631-338-6385
Mailing Address - Fax:
Practice Address - Street 1:59 VERBENA AVE
Practice Address - Street 2:
Practice Address - City:FLORAL PARK
Practice Address - State:NY
Practice Address - Zip Code:11001-2711
Practice Address - Country:US
Practice Address - Phone:631-338-6385
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-30
Last Update Date:2011-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY040430183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist