Provider Demographics
NPI:1518136944
Name:PERRY, JOHN JOSEPH (RPH)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:JOSEPH
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 1:412 W 34TH STREET
Mailing Address - Street 2:#304
Mailing Address - City:STEGER
Mailing Address - State:IL
Mailing Address - Zip Code:60475-1433
Mailing Address - Country:US
Mailing Address - Phone:330-559-9398
Mailing Address - Fax:
Practice Address - Street 1:915 S HALLECK ST
Practice Address - Street 2:
Practice Address - City:DEMOTTE
Practice Address - State:IN
Practice Address - Zip Code:46310
Practice Address - Country:US
Practice Address - Phone:219-987-6468
Practice Address - Fax:219-987-7226
Is Sole Proprietor?:No
Enumeration Date:2008-02-29
Last Update Date:2008-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVRP0007003183500000X
IN26022679A183500000X
IL183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist