Provider Demographics
NPI:1861052391
Name:CANO-PEREZ, VIVIAN MICHELLE (PHARMD, RPH)
Entity type:Individual
Prefix:
First Name:VIVIAN
Middle Name:MICHELLE
Last Name:CANO-PEREZ
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:C2 CALLE 2 VILLA REAL
Mailing Address - Street 2:
Mailing Address - City:VEGA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00693
Mailing Address - Country:US
Mailing Address - Phone:787-249-4453
Mailing Address - Fax:
Practice Address - Street 1:CALLE 2 C-2 VILLA REAL
Practice Address - Street 2:
Practice Address - City:VEGA BAJA
Practice Address - State:PUERTO RICO
Practice Address - Zip Code:00693
Practice Address - Country:UM
Practice Address - Phone:787-249-4453
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-17
Last Update Date:2019-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6649183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist