Healthcare Provider Details

I. General information

NPI: 1386200988
Provider Name (Legal Business Name): VICTOR PEGUERO PEREZ RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/20/2019
Last Update Date: 05/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4501 13TH ST
SAINT CLOUD FL
34769-6742
US

IV. Provider business mailing address

3013 BALLAD RD
KISSIMMEE FL
34746-2051
US

V. Phone/Fax

Practice location:
  • Phone: 407-957-2600
  • Fax:
Mailing address:
  • Phone: 787-525-0132
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License NumberPS54757
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: