Provider Demographics
NPI:1982917092
Name:PERRY, DEREK COMMODORE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:DEREK
Middle Name:COMMODORE
Last Name:PERRY
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 1:2700 W BASELINE RD
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85283-1072
Mailing Address - Country:US
Mailing Address - Phone:602-438-2807
Mailing Address - Fax:602-431-9592
Practice Address - Street 1:2700 W BASELINE RD
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85283-1072
Practice Address - Country:US
Practice Address - Phone:602-438-2807
Practice Address - Fax:602-431-9592
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-17
Last Update Date:2010-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS016659183500000X
NM00007153183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist