Healthcare Provider Details

I. General information

NPI: 1194484493
Provider Name (Legal Business Name): PERRY PHARMACY ENTERPRISE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2021
Last Update Date: 04/03/2023
Certification Date: 04/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 W CENTRAL AVE
CAMDEN OH
45311-1007
US

IV. Provider business mailing address

75 W CENTRAL AVE
CAMDEN OH
45311-1007
US

V. Phone/Fax

Practice location:
  • Phone: 937-452-1263
  • Fax: 937-452-3957
Mailing address:
  • Phone: 937-452-1263
  • Fax: 937-452-3957

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: KATHERINE PERRY
Title or Position: OWNER
Credential: PHARMD
Phone: 937-452-1263