Provider Demographics
NPI:1932796125
Name:GARNER, PERRY LELAND III
Entity Type:Individual
Prefix:
First Name:PERRY
Middle Name:LELAND
Last Name:GARNER
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:905 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BOONVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47601-1567
Mailing Address - Country:US
Mailing Address - Phone:812-897-8828
Mailing Address - Fax:812-897-2139
Practice Address - Street 1:905 W MAIN ST
Practice Address - Street 2:
Practice Address - City:BOONVILLE
Practice Address - State:IN
Practice Address - Zip Code:47601-1567
Practice Address - Country:US
Practice Address - Phone:812-897-8828
Practice Address - Fax:812-897-2139
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-22
Last Update Date:2020-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26023715A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist