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NPI Code Detail

MEDICARE: MISTY DAWN PEREZ PHARM D

MEDICARE:   MISTY DAWN PEREZ  PHARM D
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist47819TX

General Provider Information

NPI Number : 1467761536
Entity Type Code : Individual
Provider Name (Legal Business Name) : MISTY DAWN PEREZ PHARM D
Provider Business Mailing Address
First Line : 1909 W BROADWAY ST
Second Line :
City : CLARKSVILLE
State : TX
Zip : 75426-2010
Country : US
Telephone Number : 903-427-2050
Fax Number : 903-427-2098
Provider Business Practice Location Address
First Line : 1909 W BROADWAY ST
Second Line :
City : CLARKSVILLE
State : TX
Zip : 75426-2010
Country : US
Telephone Number : 903-427-2050
Fax Number : 903-427-2098
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/06/2010
Last Update Date : 10/06/2010

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Directions to “ MISTY DAWN PEREZ PHARM D” Practice Location

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