Provider Demographics
NPI:1366535676
Name:PERNAS, ILIANA R (PHARM D)
Entity type:Individual
Prefix:DR
First Name:ILIANA
Middle Name:R
Last Name:PERNAS
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14583 SOUTHERN BLVD
Mailing Address - Street 2:
Mailing Address - City:LOXAHATCHEE
Mailing Address - State:FL
Mailing Address - Zip Code:33470-9222
Mailing Address - Country:US
Mailing Address - Phone:561-793-3300
Mailing Address - Fax:561-793-3390
Practice Address - Street 1:14583 SOUTHERN BLVD
Practice Address - Street 2:
Practice Address - City:LOXAHATCHEE
Practice Address - State:FL
Practice Address - Zip Code:33470-9222
Practice Address - Country:US
Practice Address - Phone:561-793-3300
Practice Address - Fax:561-793-3390
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2012-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS41765183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist