Provider Demographics
NPI:1225672017
Name:PERRY, TIARA M
Entity Type:Individual
Prefix:MISS
First Name:TIARA
Middle Name:M
Last Name:PERRY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1506 E MONTAGUE AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29405-5301
Mailing Address - Country:US
Mailing Address - Phone:843-554-8867
Mailing Address - Fax:
Practice Address - Street 1:1506 E MONTAGUE AVE
Practice Address - Street 2:
Practice Address - City:N CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29405-5301
Practice Address - Country:US
Practice Address - Phone:843-554-8867
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-05
Last Update Date:2019-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC30029183700000X
SC30029254183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC30029254OtherCERTIFIED PHARMACY TECHNICIAN (CPHT)