Provider Demographics
NPI:1881429975
Name:PEREZ, KRYSTAL WIDALYS (PHT)
Entity type:Individual
Prefix:
First Name:KRYSTAL
Middle Name:WIDALYS
Last Name:PEREZ
Suffix:
Gender:F
Credentials:PHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 2 BOX 7378
Mailing Address - Street 2:
Mailing Address - City:LAS PIEDRAS
Mailing Address - State:PR
Mailing Address - Zip Code:00771-9304
Mailing Address - Country:US
Mailing Address - Phone:787-228-0861
Mailing Address - Fax:
Practice Address - Street 1:CARR #3 URB.BUZO #443 SUITE #4
Practice Address - Street 2:
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00791
Practice Address - Country:US
Practice Address - Phone:787-852-2828
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-06
Last Update Date:2024-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
010939183700000X
PR010939183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician