Provider Demographics
NPI:1629285622
Name:DIAZ, SHAIRA PEREA
Entity Type:Individual
Prefix:MRS
First Name:SHAIRA
Middle Name:PEREA
Last Name:DIAZ
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 1:189 CALLE 6
Mailing Address - Street 2:URB. BRISAS DE CEIBA
Mailing Address - City:CEIBA
Mailing Address - State:PR
Mailing Address - Zip Code:00735-3113
Mailing Address - Country:US
Mailing Address - Phone:787-607-8509
Mailing Address - Fax:
Practice Address - Street 1:PHARMACY ASSOCIATE SYSTEM
Practice Address - Street 2:APALTADO 8243
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00792
Practice Address - Country:US
Practice Address - Phone:787-285-4650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4748183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician