Provider Demographics
NPI:1598337248
Name:PEREZ, NICOLE ALEXANDRA (PHARMD)
Entity type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:ALEXANDRA
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:CARR. 863 KM. 0.6
Mailing Address - Street 2:BO. PAJAROS, CANDELARIA
Mailing Address - City:TOA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00951
Mailing Address - Country:US
Mailing Address - Phone:787-620-9611
Mailing Address - Fax:
Practice Address - Street 1:CARR. 863 KM. 0.6
Practice Address - Street 2:BO. PAJAROS, CANDELARIA
Practice Address - City:TOA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00951
Practice Address - Country:US
Practice Address - Phone:787-620-9611
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-13
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR68421835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist