=====================================================
General NPI Number Information
=====================================================
NPI Number | 1508464231
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ALEX PERRY PHARMD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/14/2020
-----------------------------------------------------
Last Update Date | 10/14/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 885 WALNUT ST
-----------------------------------------------------
City | CARY
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27511-4227
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-463-9265
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 715 LAKEMONT DR
-----------------------------------------------------
City | CLAYTON
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27520-3077
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-302-0076
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 29017
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------