sorry im sure this has been posted...
Are visa's required for US citizens?
Are malaria tablets or other vaccinations required or recommended?
I'd only be there 4 days, any reccommnedation on how to spend them?
other essential need to knows?
Visas are not required for US citizens.
If you are staying in Lima and the area around the coast you wont need Malaria tablets or Yellow Fever shot but you should think about getting your Hep A + B for sure.
In Lima definately check out the area around the PLaza De Armas and San Francisco Catacombs. Also Huacca Pucclanna was pertty interesting. You could take a bus www.cruzdelsur.com.pe down to Paracas and visit the Islas Ballestas or to Ica and go Dune Buggying and Sandboarding at Huacachina or to Naza and fly over the Nazca Lines.
This website will give you some ideas about Lima...
No and No
for activities
add Paracas Nasca for trips out but really not enough time
www.mirafloreperu.com best hotel area based on budget
Contributor 
18,660 posts
516 reviews Plaza de Armas
Two great museums: Rafael Larco de Herrera and Pedro de Osma (Barranco). If you like museums you can add others
Night time double decker tour of the colonial center
Magical Water Circuit (you can go without a tour although there are many tours that combine this with a dinner show)
enlima.com/lima/en-parque-de-la-reserva-circ…
Plus EAT EAT EAT!
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