Provider Demographics
NPI:1336541788
Name:PEREZ, KELVIN OSCAR (BS PHARM)
Entity Type:Individual
Prefix:
First Name:KELVIN
Middle Name:OSCAR
Last Name:PEREZ
Suffix:
Gender:M
Credentials:BS PHARM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2251
Mailing Address - Street 2:
Mailing Address - City:SAN SEBASTIAN
Mailing Address - State:PR
Mailing Address - Zip Code:00685-8251
Mailing Address - Country:US
Mailing Address - Phone:787-280-9032
Mailing Address - Fax:787-896-4640
Practice Address - Street 1:CARR 447 KM 3.8
Practice Address - Street 2:BO AIBONITO GUERRERO
Practice Address - City:SAN SEBASTIAN
Practice Address - State:PR
Practice Address - Zip Code:00685-8251
Practice Address - Country:US
Practice Address - Phone:787-280-9032
Practice Address - Fax:787-896-4640
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-17
Last Update Date:2016-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5001183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist