Provider Demographics
NPI:1760565790
Name:PERRY, GREGORY B (RPH)
Entity Type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:B
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 1:2823 S WALKER DR
Mailing Address - Street 2:
Mailing Address - City:LEANDER
Mailing Address - State:TX
Mailing Address - Zip Code:78641-2481
Mailing Address - Country:US
Mailing Address - Phone:512-259-3367
Mailing Address - Fax:
Practice Address - Street 1:425 UNIVERSITY BLVD STE 165
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78665-1056
Practice Address - Country:US
Practice Address - Phone:512-509-3600
Practice Address - Fax:512-509-3610
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2010-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19951183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist