Healthcare Provider Details

I. General information

NPI: 1225462443
Provider Name (Legal Business Name): VIRGINIA MARIE PEROVICH PHARMD.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/23/2013
Last Update Date: 01/30/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

137 N. HARVARD AVE.
CLAREMONT CA
91711-7011
US

IV. Provider business mailing address

7615 ETIWANDA AVE UNIT 277
RANCHO CUCAMONGA CA
91739-7011
US

V. Phone/Fax

Practice location:
  • Phone: 562-882-2828
  • Fax:
Mailing address:
  • Phone: 562-882-2828
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number69340
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number69340
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: