Provider Demographics
NPI:1770026304
Name:PEREZ QUINONES, MARIA DE LOURDES (PHARMD)
Entity type:Individual
Prefix:
First Name:MARIA DE LOURDES
Middle Name:
Last Name:PEREZ QUINONES
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1551 N FLAGLER DR
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33401-3438
Mailing Address - Country:US
Mailing Address - Phone:787-923-6963
Mailing Address - Fax:
Practice Address - Street 1:818 SOUTHERN BLVD
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33405-2530
Practice Address - Country:US
Practice Address - Phone:787-923-6963
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-30
Last Update Date:2020-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6454183500000X
FLPS59565183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist