Provider Demographics
NPI:1700103199
Name:PEREZ, LINO JR (RPH)
Entity type:Individual
Prefix:MR
First Name:LINO
Middle Name:
Last Name:PEREZ
Suffix:JR
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8006 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:BRROKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-3802
Mailing Address - Country:US
Mailing Address - Phone:347-210-8153
Mailing Address - Fax:
Practice Address - Street 1:622 W. 168TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-3748
Practice Address - Country:US
Practice Address - Phone:212-305-7130
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-26
Last Update Date:2010-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY037536183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist