Provider Demographics
NPI:1023013927
Name:PERINE ENTERPRISES INC.
Entity Type:Organization
Organization Name:PERINE ENTERPRISES INC.
Other - Org Name:DOUG'S PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PIC
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:PERINE
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:785-584-6722
Mailing Address - Street 1:PO BOX 707
Mailing Address - Street 2:
Mailing Address - City:ROSSVILLE
Mailing Address - State:KS
Mailing Address - Zip Code:66533-0707
Mailing Address - Country:US
Mailing Address - Phone:785-584-6722
Mailing Address - Fax:785-584-6513
Practice Address - Street 1:430 N MAIN ST
Practice Address - Street 2:
Practice Address - City:ROSSSVILLE
Practice Address - State:KS
Practice Address - Zip Code:66533
Practice Address - Country:US
Practice Address - Phone:785-584-6722
Practice Address - Fax:785-584-6513
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-16
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2-05477332B00000X, 333600000X, 3336C0003X, 3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100437350AMedicaid
KS1708075OtherNCPDP
KS205477OtherPHARMACY PERMIT
KS205477OtherPHARMACY PERMIT
KS100437350AMedicaid