Provider Demographics
NPI:1033400155
Name:PERRY, ERIC (ERIC PERRY)
Entity Type:Individual
Prefix:MR
First Name:ERIC
Middle Name:
Last Name:PERRY
Suffix:
Gender:M
Credentials:ERIC PERRY
Other - Prefix:
Other - First Name:ERIC
Other - Middle Name:
Other - Last Name:PERRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:810 E GLENDALE AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85020-5332
Mailing Address - Country:US
Mailing Address - Phone:480-266-0443
Mailing Address - Fax:
Practice Address - Street 1:810 E GLENDALE AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85020-5332
Practice Address - Country:US
Practice Address - Phone:480-266-0443
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-23
Last Update Date:2011-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS015119183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist