Provider Demographics
NPI:1063693505
Name:PEREZ, GERMAN (PHARMD)
Entity type:Individual
Prefix:DR
First Name:GERMAN
Middle Name:
Last Name:PEREZ
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:GERMAN
Other - Middle Name:
Other - Last Name:PEREZ
Other - Suffix:II
Other - Last Name Type:Other Name
Other - Credentials:PHARMD
Mailing Address - Street 1:16010 CROSSBAY BLVD
Mailing Address - Street 2:RITE AID
Mailing Address - City:HOWARD BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11414-3423
Mailing Address - Country:US
Mailing Address - Phone:718-845-1066
Mailing Address - Fax:718-845-1354
Practice Address - Street 1:16010 CROSSBAY BLVD
Practice Address - Street 2:RITE AID
Practice Address - City:HOWARD BEACH
Practice Address - State:NY
Practice Address - Zip Code:11414-3423
Practice Address - Country:US
Practice Address - Phone:718-845-1066
Practice Address - Fax:718-845-1354
Is Sole Proprietor?:No
Enumeration Date:2007-11-26
Last Update Date:2007-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY051287183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01440826Medicaid