Active NPI
Jessica Ines Perez, RPH
- Pharmacist
- Middletown, CT
National Provider Identifier
1730464892
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 00113322
- Practice address
- 633 Washington St
Middletown, CT 06457-2542 - Phone
- (860) 346-7628
- Fax
- (860) 346-0090
- NPI assigned
- Oct 19, 2011
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 00113322 | CT | Primary |
Addresses
Primary practice location
633 Washington St
Middletown, CT 06457-2542
Mailing address
77 Summit St
Newington, CT 06111
Phone (860) 707-9672
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0011322 | Other | CT | RPH LIC/ REG NO |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 00113322 | CT | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Eastern Co Inc | Past | Accepting new patients | |
| Walgreen Eastern Co Inc | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Pharmacy
- Middletown, CT
- NPI 1639184989
-
- Pharmacy
- Brookhaven, PA
- NPI 1215942206
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1318982400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1318982400000",
"number": "1730464892",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "77 SUMMIT ST",
"city": "NEWINGTON",
"state": "CT",
"postal_code": "06111",
"telephone_number": "860-707-9672"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "633 WASHINGTON ST",
"city": "MIDDLETOWN",
"state": "CT",
"postal_code": "064572542",
"telephone_number": "860-346-7628",
"fax_number": "860-346-0090"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PEREZ",
"first_name": "JESSICA",
"middle_name": "INES",
"credential": "RPH",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2011-10-19",
"last_updated": "2011-10-19",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "CT",
"license": "00113322",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RPH LIC/ REG NO",
"identifier": "0011322",
"state": "CT"
}
],
"endpoints": [],
"other_names": []
}Other providers in Middletown, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.