Provider Demographics
NPI:1760931323
Name:PEREIRA-DIAZ, RICARDO (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:RICARDO
Middle Name:
Last Name:PEREIRA-DIAZ
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 BLVD MEDIA LUNA
Mailing Address - Street 2:COND ALTS DEL PARQUE 1908
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00987-5093
Mailing Address - Country:US
Mailing Address - Phone:787-901-3566
Mailing Address - Fax:
Practice Address - Street 1:204 BLVD MEDIA LUNA
Practice Address - Street 2:COND ALTS DEL PARQUE 1908
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00987-5093
Practice Address - Country:US
Practice Address - Phone:787-901-3566
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-23
Last Update Date:2016-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6338183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist