Provider Demographics
NPI:1457402349
Name:PERKINS, GALEN WAYNE (RPH)
Entity type:Individual
Prefix:MR
First Name:GALEN
Middle Name:WAYNE
Last Name:PERKINS
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 1:116 ONEIDA WAY
Mailing Address - Street 2:
Mailing Address - City:MAUMELLE
Mailing Address - State:AR
Mailing Address - Zip Code:72113-5872
Mailing Address - Country:US
Mailing Address - Phone:501-258-4399
Mailing Address - Fax:
Practice Address - Street 1:7612 CANTRELL RD
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72227-3320
Practice Address - Country:US
Practice Address - Phone:501-258-4399
Practice Address - Fax:501-227-0714
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2015-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2000156307183500000X
OK11746183500000X
TX34526183500000X
KS1-14424183500000X
ARPD 10757183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO356180505Medicaid