Provider Demographics
NPI:1326173956
Name:PERRY, JONATHAN MARC (RPH)
Entity Type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:MARC
Last Name:PERRY
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 COLBERT BUSINESS PARKWAY
Mailing Address - Street 2:FRED'S PHARMACY #1394
Mailing Address - City:COLBERT
Mailing Address - State:GA
Mailing Address - Zip Code:30628
Mailing Address - Country:US
Mailing Address - Phone:706-788-2320
Mailing Address - Fax:706-788-2374
Practice Address - Street 1:15 COLBERT BUSINESS PARKWAY
Practice Address - Street 2:FRED'S PHARMACY #1394
Practice Address - City:COLBERT
Practice Address - State:GA
Practice Address - Zip Code:30628
Practice Address - Country:US
Practice Address - Phone:706-788-2320
Practice Address - Fax:706-788-2374
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2010-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH015403183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist