Provider Demographics
NPI:1609166362
Name:PEREIRA, BORIS ANDREW (PHARMACIST)
Entity Type:Individual
Prefix:MR
First Name:BORIS
Middle Name:ANDREW
Last Name:PEREIRA
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:908 MCCLOUD AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT SHASTA
Mailing Address - State:CA
Mailing Address - Zip Code:96067-9455
Mailing Address - Country:US
Mailing Address - Phone:530-926-1308
Mailing Address - Fax:530-926-1308
Practice Address - Street 1:310 W LAKE ST
Practice Address - Street 2:
Practice Address - City:MOUNT SHASTA
Practice Address - State:CA
Practice Address - Zip Code:96067-2119
Practice Address - Country:US
Practice Address - Phone:530-926-3826
Practice Address - Fax:530-926-3826
Is Sole Proprietor?:No
Enumeration Date:2011-04-15
Last Update Date:2011-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA28063183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist