Provider Demographics
NPI:1598361602
Name:PEREZ, MARIBEL
Entity Type:Individual
Prefix:
First Name:MARIBEL
Middle Name:
Last Name:PEREZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 MANHATTAN DR
Mailing Address - Street 2:
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08723-1809
Mailing Address - Country:US
Mailing Address - Phone:732-262-3864
Mailing Address - Fax:
Practice Address - Street 1:51 BANANIER DR
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-4812
Practice Address - Country:US
Practice Address - Phone:732-244-1707
Practice Address - Fax:732-736-1426
Is Sole Proprietor?:No
Enumeration Date:2020-12-05
Last Update Date:2020-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02455600183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist