Provider Demographics
NPI:1720559297
Name:PERRY, DANEDRIA (RPH)
Entity Type:Individual
Prefix:DR
First Name:DANEDRIA
Middle Name:
Last Name:PERRY
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 1:9807 SANFORD ARBOR LN
Mailing Address - Street 2:
Mailing Address - City:THONOTOSASSA
Mailing Address - State:FL
Mailing Address - Zip Code:33592-3399
Mailing Address - Country:US
Mailing Address - Phone:813-679-8531
Mailing Address - Fax:
Practice Address - Street 1:3015 SW PINE ISLAND RD
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33991-1703
Practice Address - Country:US
Practice Address - Phone:239-282-5530
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-10
Last Update Date:2018-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS58650183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist