Provider Demographics
NPI:1669882999
Name:PERRIN, KENNETH LEE (PHARMD)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:LEE
Last Name:PERRIN
Suffix:
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 1:7815 N PALM AVE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93711-5530
Mailing Address - Country:US
Mailing Address - Phone:559-476-8025
Mailing Address - Fax:559-476-8001
Practice Address - Street 1:7815 N PALM AVE
Practice Address - Street 2:SUITE 400
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93711-5530
Practice Address - Country:US
Practice Address - Phone:559-476-8025
Practice Address - Fax:559-476-8001
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-08
Last Update Date:2014-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31568183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist