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General NPI Number Information
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NPI Number | 1609166362
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Entity Type | Individual
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Provider Name | BORIS ANDREW PEREIRA PHARMACIST
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Gender | Male
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Dates
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Enumeration Date | 04/15/2011
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Last Update Date | 04/15/2011
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Provider Practice Location Address
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Address Line | 310 W LAKE ST
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City | MOUNT SHASTA
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State | CA
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Zip | 96067-2119
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Country | US
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Telephone | 530-926-3826
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Fax | 530-926-3826
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Provider Business Mailing Address
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Address Line | 908 MCCLOUD AVE
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City | MOUNT SHASTA
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State | CA
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Zip | 96067-9455
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Country | US
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Telephone | 530-926-1308
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Fax | 530-926-1308
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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 | 28063
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License Number State | CA
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