Provider Demographics
NPI:1073827614
Name:PERRY, ALITA M (RPH)
Entity Type:Individual
Prefix:MRS
First Name:ALITA
Middle Name:M
Last Name:PERRY
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14281 CAT DEAKLE RD
Mailing Address - Street 2:
Mailing Address - City:GRAND BAY
Mailing Address - State:AL
Mailing Address - Zip Code:36541-3361
Mailing Address - Country:US
Mailing Address - Phone:251-865-0218
Mailing Address - Fax:251-639-5125
Practice Address - Street 1:14281 CAT DEAKLE RD
Practice Address - Street 2:
Practice Address - City:GRAND BAY
Practice Address - State:AL
Practice Address - Zip Code:36541-3361
Practice Address - Country:US
Practice Address - Phone:251-865-0218
Practice Address - Fax:251-639-5125
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-05
Last Update Date:2010-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA15788183500000X
MSE7809183500000X
AL16299183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA15788OtherLA BOARD OF PHARMACY
AL16299OtherALA BOARD OF PHARMACY
MSE7809OtherMS. BOARD OF PHARMACY