Provider Demographics
NPI:1962130641
Name:HERRERA PEREZ, BLADIMIR (PHARMD)
Entity type:Individual
Prefix:
First Name:BLADIMIR
Middle Name:
Last Name:HERRERA PEREZ
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 AVE JESUS T PINERO APT 9L
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918-4137
Mailing Address - Country:US
Mailing Address - Phone:787-238-5501
Mailing Address - Fax:
Practice Address - Street 1:374 AVE PONCE DE LEON
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-2024
Practice Address - Country:US
Practice Address - Phone:787-238-5501
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-10
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7039183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR7039OtherHEALTH DEPARTMENT