Provider Demographics
NPI:1871675678
Name:PERRY PHARMACY ENTERPRISE LLC
Entity Type:Organization
Organization Name:PERRY PHARMACY ENTERPRISE LLC
Other - Org Name:CAMDEN VILLAGE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:PERRY
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:937-336-3637
Mailing Address - Street 1:75 W CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:OH
Mailing Address - Zip Code:45311
Mailing Address - Country:US
Mailing Address - Phone:937-452-1263
Mailing Address - Fax:937-452-3957
Practice Address - Street 1:75 W CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:OH
Practice Address - Zip Code:45311
Practice Address - Country:US
Practice Address - Phone:937-452-1263
Practice Address - Fax:937-452-3957
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-20
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336C0004X
OHRTP.020187400-033336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2075910OtherPK
OH0492926Medicaid
0771050001Medicare NSC