Provider Demographics
NPI:1144735200
Name:PERKINS, GARY ALLEN
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:ALLEN
Last Name:PERKINS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2038 US HIGHWAY 98 W
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32459-5322
Mailing Address - Country:US
Mailing Address - Phone:850-267-0582
Mailing Address - Fax:850-267-0582
Practice Address - Street 1:2038 US HIGHWAY 98 W
Practice Address - Street 2:
Practice Address - City:SANTA ROSA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32459-5322
Practice Address - Country:US
Practice Address - Phone:850-267-0582
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-11
Last Update Date:2017-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS47629183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist