Healthcare Provider Details

I. General information

NPI: 1225672017
Provider Name (Legal Business Name): MISS TIARA M. PERRY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/05/2019
Last Update Date: 11/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1506 E MONTAGUE AVE
N CHARLESTON SC
29405-5301
US

IV. Provider business mailing address

1506 E MONTAGUE AVE
NORTH CHARLESTON SC
29405-5301
US

V. Phone/Fax

Practice location:
  • Phone: 843-554-8867
  • Fax:
Mailing address:
  • Phone: 843-554-8867
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number30029
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number30029254
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: