Provider Demographics
NPI:1700121423
Name:PERDUE, DAVID ALLEN (RPH)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:ALLEN
Last Name:PERDUE
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 1:80 BAYLOR DR
Mailing Address - Street 2:
Mailing Address - City:BLUFFTON
Mailing Address - State:SC
Mailing Address - Zip Code:29910-8902
Mailing Address - Country:US
Mailing Address - Phone:843-706-3504
Mailing Address - Fax:843-706-3757
Practice Address - Street 1:80 BAYLOR DR
Practice Address - Street 2:
Practice Address - City:BLUFFTON
Practice Address - State:SC
Practice Address - Zip Code:29910-8902
Practice Address - Country:US
Practice Address - Phone:843-706-3504
Practice Address - Fax:843-706-3757
Is Sole Proprietor?:No
Enumeration Date:2012-12-06
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6649183500000X
NC9078183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist