Provider Demographics
NPI:1407670292
Name:PERAZA LOPEZ, GLEIDY (PHARMD)
Entity type:Individual
Prefix:
First Name:GLEIDY
Middle Name:
Last Name:PERAZA LOPEZ
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 1:601 SW 113TH WAY
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33025-3440
Mailing Address - Country:US
Mailing Address - Phone:786-315-8216
Mailing Address - Fax:
Practice Address - Street 1:6690 EAGLE NEST LN
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33014-2264
Practice Address - Country:US
Practice Address - Phone:305-821-1402
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-08
Last Update Date:2024-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS67923183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist