Provider Demographics
NPI:1770173502
Name:PEREGRINO, JOSHUA DAVID (PHARMD)
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:DAVID
Last Name:PEREGRINO
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 1:8715 W HIGHWAY 71 APT 3103
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78735-0035
Mailing Address - Country:US
Mailing Address - Phone:409-225-1394
Mailing Address - Fax:
Practice Address - Street 1:3702 RANCH ROAD 620 S
Practice Address - Street 2:
Practice Address - City:BEE CAVE
Practice Address - State:TX
Practice Address - Zip Code:78738-6304
Practice Address - Country:US
Practice Address - Phone:512-651-0095
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-25
Last Update Date:2021-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX67270183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist