Provider Demographics
NPI:1982472064
Name:PEREZ, LISA RATHOD (PHARMD)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:RATHOD
Last Name:PEREZ
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 1:19 CHAPIN RD.
Mailing Address - Street 2:BUILDING D, SUITE D7
Mailing Address - City:PINE BROOK
Mailing Address - State:NJ
Mailing Address - Zip Code:07058
Mailing Address - Country:US
Mailing Address - Phone:551-697-7911
Mailing Address - Fax:844-225-9055
Practice Address - Street 1:19 CHAPIN RD.
Practice Address - Street 2:BUILDING D, SUITE D7
Practice Address - City:PINE BROOK
Practice Address - State:NJ
Practice Address - Zip Code:07058
Practice Address - Country:US
Practice Address - Phone:973-461-0100
Practice Address - Fax:844-225-9055
Is Sole Proprietor?:No
Enumeration Date:2023-12-18
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03654200183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist