Provider Demographics
NPI:1881678142
Name:PERRY, MATTHEW R (RPH)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:R
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 1:12200 W 106TH ST
Mailing Address - Street 2:SUITE 140
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66215-2305
Mailing Address - Country:US
Mailing Address - Phone:913-541-5700
Mailing Address - Fax:913-541-6028
Practice Address - Street 1:12200 W 106TH ST
Practice Address - Street 2:SUITE 140
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66215-2305
Practice Address - Country:US
Practice Address - Phone:913-541-5700
Practice Address - Fax:913-541-6028
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-30
Last Update Date:2010-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11833183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist