Provider Demographics
NPI:1396053781
Name:PEREZ, JUAN ANTONIO (PHARMD)
Entity type:Individual
Prefix:
First Name:JUAN
Middle Name:ANTONIO
Last Name:PEREZ
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 1:1121 E SAINT FRANCIS AVE
Mailing Address - Street 2:
Mailing Address - City:ALTON
Mailing Address - State:TX
Mailing Address - Zip Code:78573-9833
Mailing Address - Country:US
Mailing Address - Phone:956-432-5061
Mailing Address - Fax:
Practice Address - Street 1:200 E GRIFFIN PKWY
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-2912
Practice Address - Country:US
Practice Address - Phone:956-424-7920
Practice Address - Fax:956-424-7945
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-20
Last Update Date:2010-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX41250183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist