Provider Demographics
NPI:1558381756
Name:PERDUE, CHARLOTTE M (RPH)
Entity Type:Individual
Prefix:MRS
First Name:CHARLOTTE
Middle Name:M
Last Name:PERDUE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2455 TRIMBLE RD
Mailing Address - Street 2:
Mailing Address - City:ADAIRVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42202-8038
Mailing Address - Country:US
Mailing Address - Phone:270-539-3135
Mailing Address - Fax:
Practice Address - Street 1:7802 HIGHWAY 25E
Practice Address - Street 2:
Practice Address - City:CROSS PLAINS
Practice Address - State:TN
Practice Address - Zip Code:37049
Practice Address - Country:US
Practice Address - Phone:615-654-3877
Practice Address - Fax:615-654-9179
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4305183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist