Provider Demographics
NPI:1366864266
Name:PERDUE, GEORGE III (RPH)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:
Last Name:PERDUE
Suffix:III
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 1:100 POLARIS PKWY
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43082-6070
Mailing Address - Country:US
Mailing Address - Phone:614-865-2010
Mailing Address - Fax:614-865-2065
Practice Address - Street 1:100 POLARIS PKWY
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43082-6070
Practice Address - Country:US
Practice Address - Phone:614-865-2010
Practice Address - Fax:614-865-2065
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-10
Last Update Date:2014-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03212750183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist