Healthcare Provider Details

I. General information

NPI: 1326173956
Provider Name (Legal Business Name): JONATHAN MARC PERRY RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2007
Last Update Date: 08/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 COLBERT BUSINESS PARKWAY FRED'S PHARMACY #1394
COLBERT GA
30628
US

IV. Provider business mailing address

15 COLBERT BUSINESS PARKWAY FRED'S PHARMACY #1394
COLBERT GA
30628
US

V. Phone/Fax

Practice location:
  • Phone: 706-788-2320
  • Fax: 706-788-2374
Mailing address:
  • Phone: 706-788-2320
  • Fax: 706-788-2374

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH015403
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: