Provider Demographics
NPI:1891280863
Name:PERKINS, EDWIN WILLIS
Entity Type:Individual
Prefix:MR
First Name:EDWIN
Middle Name:WILLIS
Last Name:PERKINS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:EDWIN
Other - Middle Name:WILLIS
Other - Last Name:PERKINS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RRH
Mailing Address - Street 1:4015 20TH ST
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-2403
Mailing Address - Country:US
Mailing Address - Phone:772-978-6470
Mailing Address - Fax:772-978-6471
Practice Address - Street 1:4015 20TH ST
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-2403
Practice Address - Country:US
Practice Address - Phone:772-978-6470
Practice Address - Fax:772-978-6471
Is Sole Proprietor?:No
Enumeration Date:2018-06-22
Last Update Date:2018-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS20083183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPS20083Other183500000X-PHARMACIST
FLPS20083OtherPHARMACIST