Provider Demographics
NPI:1104910835
Name:PERKINS, MITZI NICHOLS (RPH)
Entity type:Individual
Prefix:MRS
First Name:MITZI
Middle Name:NICHOLS
Last Name:PERKINS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:MRS
Other - First Name:MITZI
Other - Middle Name:NICHOLS
Other - Last Name:PERKINS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RPH
Mailing Address - Street 1:335 JONAQUIN CIRCLE
Mailing Address - Street 2:
Mailing Address - City:HOPKINSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42240
Mailing Address - Country:US
Mailing Address - Phone:270-885-8430
Mailing Address - Fax:
Practice Address - Street 1:320 W 18TH STREET
Practice Address - Street 2:JENNIE STUART MEDICAL CENTER
Practice Address - City:HOPKINSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42240
Practice Address - Country:US
Practice Address - Phone:270-887-0166
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY8914183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY8914OtherRPH