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General NPI Number Information
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NPI Number | 1750384673
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Entity Type | Individual
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Provider Name | ELIZABETH D PEREA PHARM D., PHC
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Gender | Female
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Dates
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Enumeration Date | 05/24/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 801 VASSAR DR NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87106-2725
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Country | US
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Telephone | 505-248-7731
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Fax | 505-248-7642
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Provider Business Mailing Address
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Address Line | 8631 CASA VERDE AVE NW
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City | ALBUQUERQUE
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State | NM
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Zip | 87120-2868
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Country | US
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Telephone | 505-352-6046
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Fax | 505-248-7642
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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 | 1835P1200X
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Taxonomy Name | Pharmacotherapy Pharmacist
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License Number | RP6462 AND PHC90
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License Number State | NM
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