Provider Demographics
NPI:1174709216
Name:PEREZ-LEROUZIC, MARTA VIRGINIA (RPH)
Entity type:Individual
Prefix:MRS
First Name:MARTA
Middle Name:VIRGINIA
Last Name:PEREZ-LEROUZIC
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 1:254 HILLSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:WILLISTON PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11596-2201
Mailing Address - Country:US
Mailing Address - Phone:516-739-2980
Mailing Address - Fax:516-739-1853
Practice Address - Street 1:254 HILLSIDE AVE
Practice Address - Street 2:
Practice Address - City:WILLISTON PARK
Practice Address - State:NY
Practice Address - Zip Code:11596-2201
Practice Address - Country:US
Practice Address - Phone:516-739-2980
Practice Address - Fax:516-739-1853
Is Sole Proprietor?:No
Enumeration Date:2008-01-19
Last Update Date:2008-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY043912183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist