Provider Demographics
NPI:1821709791
Name:PEREGRINO, EARLMATTHEW (RPH, PHARMD)
Entity Type:Individual
Prefix:
First Name:EARLMATTHEW
Middle Name:
Last Name:PEREGRINO
Suffix:
Gender:M
Credentials:RPH, PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6042 CROWN PALMS AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89139-6976
Mailing Address - Country:US
Mailing Address - Phone:775-762-2359
Mailing Address - Fax:
Practice Address - Street 1:501 S RANCHO DR STE G46
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106-4835
Practice Address - Country:US
Practice Address - Phone:702-912-4844
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-12
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV23299183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty