Provider Demographics
NPI:1962002360
Name:PERRY, PAUL JAMES (RPH)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:JAMES
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:PO BOX 57
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63825-0057
Mailing Address - Country:US
Mailing Address - Phone:573-624-0493
Mailing Address - Fax:
Practice Address - Street 1:2025 W BUS HIGHWAY 60
Practice Address - Street 2:
Practice Address - City:DEXTER
Practice Address - State:MO
Practice Address - Zip Code:63841-2879
Practice Address - Country:US
Practice Address - Phone:573-624-5967
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-27
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO028852183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist