Provider Demographics
NPI:1932241478
Name:PEREZPAGAN, WANDA I (RPH)
Entity Type:Individual
Prefix:MRS
First Name:WANDA
Middle Name:I
Last Name:PEREZPAGAN
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:HC 6 BOX 13795
Mailing Address - Street 2:
Mailing Address - City:HATILLO
Mailing Address - State:PR
Mailing Address - Zip Code:00659-9544
Mailing Address - Country:US
Mailing Address - Phone:787-544-7602
Mailing Address - Fax:
Practice Address - Street 1:12 CALLE INFANZON
Practice Address - Street 2:
Practice Address - City:CAMUY
Practice Address - State:PR
Practice Address - Zip Code:00627-2611
Practice Address - Country:US
Practice Address - Phone:787-898-3447
Practice Address - Fax:787-898-3447
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3441183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR3441OtherPHARMACIST LICENSE