Provider Demographics
NPI:1265798128
Name:PERRY, KEITH D JR (PHARM D)
Entity type:Individual
Prefix:DR
First Name:KEITH
Middle Name:D
Last Name:PERRY
Suffix:JR
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1380 BRAMBLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33811-2941
Mailing Address - Country:US
Mailing Address - Phone:863-255-8670
Mailing Address - Fax:
Practice Address - Street 1:1380 BRAMBLEWOOD DR
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33811-2941
Practice Address - Country:US
Practice Address - Phone:863-255-8670
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-04
Last Update Date:2012-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS46882183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist