MEDICARE: MR. EDWIN WILLIS PERKINS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	PS20083	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PS20083	OTHER	FL	183500000X-PHARMACIST
2	PS20083	OTHER	FL	PHARMACIST

General Provider Information

NPI Number	:	1891280863
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. EDWIN WILLIS PERKINS

Provider Business Mailing Address
First Line	:	4015 20TH ST
Second Line	:
City	:	VERO BEACH
State	:	FL
Zip	:	32960-2403
Country	:	US
Telephone Number	:	772-978-6470
Fax Number	:	772-978-6471

Provider Business Practice Location Address
First Line	:	4015 20TH ST
Second Line	:
City	:	VERO BEACH
State	:	FL
Zip	:	32960-2403
Country	:	US
Telephone Number	:	772-978-6470
Fax Number	:	772-978-6471

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/22/2018
Last Update Date	:	06/22/2018

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