Provider Demographics
NPI:1558871665
Name:PEREZ, NELSON E JR (RPH PHARMD)
Entity Type:Individual
Prefix:DR
First Name:NELSON
Middle Name:E
Last Name:PEREZ
Suffix:JR
Gender:M
Credentials:RPH PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12601 NW 32ND MNR
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33323-6354
Mailing Address - Country:US
Mailing Address - Phone:954-579-2864
Mailing Address - Fax:
Practice Address - Street 1:1873 LANTANA RD
Practice Address - Street 2:
Practice Address - City:LANTANA
Practice Address - State:FL
Practice Address - Zip Code:33462-2601
Practice Address - Country:US
Practice Address - Phone:561-533-5522
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-03
Last Update Date:2017-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS52406183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist