Provider Demographics
NPI:1639718448
Name:LANG PEREZ, SOFIA GABRIELA (PHARMD)
Entity Type:Individual
Prefix:
First Name:SOFIA
Middle Name:GABRIELA
Last Name:LANG PEREZ
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1450 ASHFORD AVENUE
Mailing Address - Street 2:APT. 7B
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00907
Mailing Address - Country:US
Mailing Address - Phone:787-340-1473
Mailing Address - Fax:
Practice Address - Street 1:CVS PHARMACY
Practice Address - Street 2:AVE. PARKSIDE, PUEBLO VIEJO WARD
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00968
Practice Address - Country:US
Practice Address - Phone:787-792-0780
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-26
Last Update Date:2019-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6679183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty