Provider Demographics
NPI:1083615769
Name:PERKINS, DWIGHT KEITH (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:DWIGHT
Middle Name:KEITH
Last Name:PERKINS
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:319 NE WARRINGTON CT
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64064-1605
Mailing Address - Country:US
Mailing Address - Phone:816-478-1349
Mailing Address - Fax:
Practice Address - Street 1:9100 W 74TH ST
Practice Address - Street 2:SMMC - PHARMACY
Practice Address - City:MERRIAM
Practice Address - State:KS
Practice Address - Zip Code:66204-4004
Practice Address - Country:US
Practice Address - Phone:913-676-8106
Practice Address - Fax:913-789-3175
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-12713183500000X
MO041611183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist