Provider Demographics
NPI:1568744001
Name:PEREZ, KIMBERLY (PHARM D)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
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 1:7113 CERMAK RD
Mailing Address - Street 2:
Mailing Address - City:BERWYN
Mailing Address - State:IL
Mailing Address - Zip Code:60402-2103
Mailing Address - Country:US
Mailing Address - Phone:708-795-9030
Mailing Address - Fax:708-795-8032
Practice Address - Street 1:7113 CERMAK RD
Practice Address - Street 2:
Practice Address - City:BERWYN
Practice Address - State:IL
Practice Address - Zip Code:60402-2103
Practice Address - Country:US
Practice Address - Phone:708-795-9030
Practice Address - Fax:708-795-8032
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-11
Last Update Date:2011-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.290592183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist