Provider Demographics
NPI:1457429300
Name:PEREZ-GOMEZ, EDITH (RPH)
Entity Type:Individual
Prefix:MRS
First Name:EDITH
Middle Name:
Last Name:PEREZ-GOMEZ
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:PO BOX 8681
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00732-8681
Mailing Address - Country:US
Mailing Address - Phone:787-841-3515
Mailing Address - Fax:787-841-3515
Practice Address - Street 1:ST. 3 # D-10
Practice Address - Street 2:URB.HCDA.SAN JOSE
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00730
Practice Address - Country:US
Practice Address - Phone:787-841-3515
Practice Address - Fax:787-841-3515
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4116183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist