Provider Demographics
NPI:1528378791
Name:PERRY, JASON R (RPH)
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:R
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 1:800 BIERMANN CT STE A
Mailing Address - Street 2:
Mailing Address - City:MT PROSPECT
Mailing Address - State:IL
Mailing Address - Zip Code:60056-2151
Mailing Address - Country:US
Mailing Address - Phone:909-799-4174
Mailing Address - Fax:909-799-4364
Practice Address - Street 1:800 BIERMANN CT STE A
Practice Address - Street 2:
Practice Address - City:MT PROSPECT
Practice Address - State:IL
Practice Address - Zip Code:60056-2151
Practice Address - Country:US
Practice Address - Phone:909-799-4174
Practice Address - Fax:909-799-4364
Is Sole Proprietor?:No
Enumeration Date:2010-10-20
Last Update Date:2010-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.289996183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist