Provider Demographics
NPI:1750384673
Name:PEREA, ELIZABETH D (PHARM D, PHC)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:D
Last Name:PEREA
Suffix:
Gender:F
Credentials:PHARM D, PHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8631 CASA VERDE AVE NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87120-2868
Mailing Address - Country:US
Mailing Address - Phone:505-352-6046
Mailing Address - Fax:505-248-7642
Practice Address - Street 1:801 VASSAR DR NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-2725
Practice Address - Country:US
Practice Address - Phone:505-248-7731
Practice Address - Fax:505-248-7642
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRP6462 AND PHC901835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy