Provider Demographics
NPI:1760857205
Name:PERRY, JAMES B (RPH)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:B
Last Name:PERRY
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:JAMES
Other - Middle Name:B
Other - Last Name:PERRY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMACIST
Mailing Address - Street 1:11014 CEDAR CREEK DR
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91737-7855
Mailing Address - Country:US
Mailing Address - Phone:909-354-2003
Mailing Address - Fax:909-987-7974
Practice Address - Street 1:11014 CEDAR CREEK DR
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91737-7855
Practice Address - Country:US
Practice Address - Phone:909-354-2003
Practice Address - Fax:909-987-7974
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-09
Last Update Date:2015-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA37595183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist