Healthcare Provider Details

I. General information

NPI: 1225418056
Provider Name (Legal Business Name): JUDITH PEREZ PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2015
Last Update Date: 06/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 PRESIDENTIAL WAY
WEST PALM BEACH FL
33401-1800
US

IV. Provider business mailing address

7790 LAGO DEL MAR DR APT 904
BOCA RATON FL
33433-4908
US

V. Phone/Fax

Practice location:
  • Phone: 561-686-8200
  • Fax:
Mailing address:
  • Phone: 561-400-9493
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPU7277
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License NumberPS46994
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: