Provider Demographics
NPI:1255097119
Name:PEREGO-FLAMM, SYLVIA (RPH)
Entity type:Individual
Prefix:
First Name:SYLVIA
Middle Name:
Last Name:PEREGO-FLAMM
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 FUNSTON RD BLDG 2542
Mailing Address - Street 2:
Mailing Address - City:FORT SAM HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:78234-7667
Mailing Address - Country:US
Mailing Address - Phone:210-221-3941
Mailing Address - Fax:
Practice Address - Street 1:2500 FUNSTON RD BLDG 2542
Practice Address - Street 2:
Practice Address - City:FORT SAM HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:78234-7667
Practice Address - Country:US
Practice Address - Phone:210-221-3941
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-15
Last Update Date:2021-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX35939183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist