Provider Demographics
NPI:1114404241
Name:PERRY, DEREK (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:DEREK
Middle Name:
Last Name:PERRY
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 1:8500 N WICKHAM RD
Mailing Address - Street 2:
Mailing Address - City:VIERA
Mailing Address - State:FL
Mailing Address - Zip Code:32940-6600
Mailing Address - Country:US
Mailing Address - Phone:321-242-6778
Mailing Address - Fax:321-242-9429
Practice Address - Street 1:8500 N WICKHAM RD
Practice Address - Street 2:
Practice Address - City:VIERA
Practice Address - State:FL
Practice Address - Zip Code:32940-6600
Practice Address - Country:US
Practice Address - Phone:321-242-6778
Practice Address - Fax:321-242-9429
Is Sole Proprietor?:No
Enumeration Date:2018-07-21
Last Update Date:2018-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS44328183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist