Provider Demographics
NPI:1801828959
Name:PERDUE, MICHAEL FORREST (RPH)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:FORREST
Last Name:PERDUE
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 1:1540 SPRING VALLEY DR
Mailing Address - Street 2:PHARMACY SERVICE (119)
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25704-9300
Mailing Address - Country:US
Mailing Address - Phone:304-429-6755
Mailing Address - Fax:304-429-0273
Practice Address - Street 1:1540 SPRING VALLEY DR
Practice Address - Street 2:PHARMACY SERVICE (119)
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25704-9300
Practice Address - Country:US
Practice Address - Phone:304-429-6755
Practice Address - Fax:304-429-0273
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY9691183500000X, 1835P1200X, 207K00000X, 207KA0200X, 207KI0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered183500000XPharmacy Service ProvidersPharmacist
Not Answered1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy
Not Answered207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Not Answered207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
Not Answered207KI0005XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyClinical & Laboratory Immunology