Healthcare Provider Details

I. General information

NPI: 1619897394
Provider Name (Legal Business Name): CHARLES PERRIN PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2026
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 W 40TH AVE
PINE BLUFF AR
71603-6301
US

IV. Provider business mailing address

3605 INDEPENDENCE DR
BRYANT AR
72022-7025
US

V. Phone/Fax

Practice location:
  • Phone: 870-541-7100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPD09729
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: