Provider Demographics
NPI:1962928499
Name:PEREZ, PAULA M (PHARMACIST)
Entity type:Individual
Prefix:
First Name:PAULA
Middle Name:M
Last Name:PEREZ
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 FLORENCE ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06040-5405
Mailing Address - Country:US
Mailing Address - Phone:203-918-1800
Mailing Address - Fax:
Practice Address - Street 1:529 TALCOTTVILLE RD
Practice Address - Street 2:
Practice Address - City:VERNON ROCKVILLE
Practice Address - State:CT
Practice Address - Zip Code:06066-2311
Practice Address - Country:US
Practice Address - Phone:860-871-6068
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-16
Last Update Date:2017-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTPCT.0014216183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist