Provider Demographics
NPI:1215147889
Name:PEREZ, EVELYN ZOE (PH)
Entity type:Individual
Prefix:
First Name:EVELYN
Middle Name:ZOE
Last Name:PEREZ
Suffix:
Gender:F
Credentials:PH
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
Mailing Address - Street 2:198
Mailing Address - City:GUANICA
Mailing Address - State:PR
Mailing Address - Zip Code:00653
Mailing Address - Country:US
Mailing Address - Phone:787-475-6565
Mailing Address - Fax:
Practice Address - Street 1:CALLE MUNOZ RIVERA
Practice Address - Street 2:#8
Practice Address - City:SAN LORENZO
Practice Address - State:PR
Practice Address - Zip Code:00754
Practice Address - Country:UM
Practice Address - Phone:787-736-4845
Practice Address - Fax:787-736-4020
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5084183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist