Provider Demographics
NPI:1508140328
Name:PERKINS, EUGENE WAYNE JR (RPH)
Entity Type:Individual
Prefix:MR
First Name:EUGENE
Middle Name:WAYNE
Last Name:PERKINS
Suffix:JR
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 1:1406 DESOTO DR
Mailing Address - Street 2:
Mailing Address - City:O'FALLON
Mailing Address - State:IL
Mailing Address - Zip Code:62269-2807
Mailing Address - Country:US
Mailing Address - Phone:618-632-7454
Mailing Address - Fax:
Practice Address - Street 1:704 CAMBRIDGE BLVD
Practice Address - Street 2:
Practice Address - City:O'FALLON
Practice Address - State:IL
Practice Address - Zip Code:62269-2807
Practice Address - Country:US
Practice Address - Phone:618-632-6920
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-29
Last Update Date:2011-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.031899183500000X
MO028163183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist