Provider Demographics
NPI:1841249315
Name:PERRY, SUSAN (RPH CPH)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:PERRY
Suffix:
Gender:F
Credentials:RPH CPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9252 SAN JOSE BLVD
Mailing Address - Street 2:STE 3304
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32257-9225
Mailing Address - Country:US
Mailing Address - Phone:904-737-4664
Mailing Address - Fax:
Practice Address - Street 1:9252 SAN JOSE BLVD
Practice Address - Street 2:STE 3304
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32257-9225
Practice Address - Country:US
Practice Address - Phone:904-737-4664
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS40817183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPS40817OtherPHARMACIST