Provider Demographics
NPI:1619980661
Name:PERRY, RISA DENELLE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:RISA
Middle Name:DENELLE
Last Name:PERRY
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2800 RADIO RD
Mailing Address - Street 2:
Mailing Address - City:ALMO
Mailing Address - State:KY
Mailing Address - Zip Code:42020-9436
Mailing Address - Country:US
Mailing Address - Phone:270-753-3634
Mailing Address - Fax:270-753-3652
Practice Address - Street 1:2800 RADIO RD
Practice Address - Street 2:
Practice Address - City:ALMO
Practice Address - State:KY
Practice Address - Zip Code:42020-9436
Practice Address - Country:US
Practice Address - Phone:270-753-3634
Practice Address - Fax:270-753-3652
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY012596183500000X
MI5302027211183500000X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered183500000XPharmacy Service ProvidersPharmacist
Not Answered332B00000XSuppliersDurable Medical Equipment & Medical Supplies