Provider Demographics
NPI:1366562175
Name:PEREZ, MYRIAM DAISY (PHARMACIST)
Entity type:Individual
Prefix:
First Name:MYRIAM
Middle Name:DAISY
Last Name:PEREZ
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5464
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00726-5464
Mailing Address - Country:US
Mailing Address - Phone:787-746-4778
Mailing Address - Fax:787-746-4778
Practice Address - Street 1:AVE DEGETAU
Practice Address - Street 2:117 FARMACIA BONNEVILLE
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725-5819
Practice Address - Country:US
Practice Address - Phone:787-746-4778
Practice Address - Fax:787-746-4778
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR08-F-22433336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy