Healthcare Provider Details

I. General information

NPI: 1689909079
Provider Name (Legal Business Name): DONALD GUY PERRIN R.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2009
Last Update Date: 10/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 N BROADWAY
PELICAN RAPIDS MN
56572-4138
US

IV. Provider business mailing address

11 N BROADWAY P.O. BOX 621
PELICAN RAPIDS MN
56572-4138
US

V. Phone/Fax

Practice location:
  • Phone: 218-863-1441
  • Fax: 218-863-1558
Mailing address:
  • Phone: 218-863-1441
  • Fax: 218-863-1558

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number112381
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: