Provider Demographics
NPI:1295512903
Name:PERDUE, KEVIN JR (PHARMD)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:
Last Name:PERDUE
Suffix:JR
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 E BEACH PROMENADE
Mailing Address - Street 2:
Mailing Address - City:LINDENHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11757-6802
Mailing Address - Country:US
Mailing Address - Phone:631-804-9790
Mailing Address - Fax:
Practice Address - Street 1:225 COMMUNITY DR STE 140
Practice Address - Street 2:
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-5506
Practice Address - Country:US
Practice Address - Phone:631-804-9790
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-14
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY070640183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist