Provider Demographics
NPI:1346495611
Name:DILLARD, PERRY LAWRENCE (R PH)
Entity Type:Individual
Prefix:
First Name:PERRY
Middle Name:LAWRENCE
Last Name:DILLARD
Suffix:
Gender:M
Credentials:R PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4211 HOSPITAL ST
Mailing Address - Street 2:SUITE 302
Mailing Address - City:PASCAGOULA
Mailing Address - State:MS
Mailing Address - Zip Code:39581-5320
Mailing Address - Country:US
Mailing Address - Phone:228-712-2610
Mailing Address - Fax:228-712-2609
Practice Address - Street 1:4211 HOSPITAL ST
Practice Address - Street 2:SUITE 302
Practice Address - City:PASCAGOULA
Practice Address - State:MS
Practice Address - Zip Code:39581-5320
Practice Address - Country:US
Practice Address - Phone:228-712-2610
Practice Address - Fax:228-712-2609
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-29
Last Update Date:2008-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE0061041835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist