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General NPI Number Information
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NPI Number | 1255114674
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Entity Type | Individual
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Provider Name | ERNESTO PEREZ
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Gender | Male
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Dates
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Enumeration Date | 08/17/2023
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Last Update Date | 08/17/2023
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Provider Practice Location Address
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Address Line | 1537 NW SAINT LUCIE WEST BLVD
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City | PORT ST LUCIE
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State | FL
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Zip | 34986-2113
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Country | US
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Telephone | 772-340-4350
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Fax |
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Provider Business Mailing Address
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Address Line | 192 SE SONETO CT
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City | PORT ST LUCIE
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State | FL
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Zip | 34983-2031
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Country | US
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Telephone | 772-828-6927
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | PS66198
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License Number State | FL
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