Healthcare Provider Details

I. General information

NPI: 1831019074
Provider Name (Legal Business Name): CORY PERRY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2026
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5241 W 130TH TER
LEAWOOD KS
66209-1815
US

IV. Provider business mailing address

5241 W 130TH TER
LEAWOOD KS
66209-1815
US

V. Phone/Fax

Practice location:
  • Phone: 785-250-4103
  • Fax:
Mailing address:
  • Phone: 785-250-4103
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835X0200X
TaxonomyOncology Pharmacist
License Number1-105890
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: