Provider Demographics
NPI:1013330067
Name:PERRY, MARLENA MAYES (PHARMD)
Entity Type:Individual
Prefix:
First Name:MARLENA
Middle Name:MAYES
Last Name:PERRY
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:MARLENA
Other - Middle Name:ADRIONE
Other - Last Name:MAYES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:2001 BRYAN ST
Mailing Address - Street 2:SUITE 2800
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75201-3002
Mailing Address - Country:US
Mailing Address - Phone:214-820-2150
Mailing Address - Fax:214-818-2512
Practice Address - Street 1:2001 BRYAN ST
Practice Address - Street 2:SUITE 2800
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75201-3002
Practice Address - Country:US
Practice Address - Phone:214-820-2150
Practice Address - Fax:214-818-2512
Is Sole Proprietor?:No
Enumeration Date:2014-01-28
Last Update Date:2016-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX40917183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist