Provider Demographics
NPI:1124313275
Name:PERRY, SCOTT WILLIAM (RPH)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:WILLIAM
Last Name:PERRY
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 INDEPENDENCE WAY
Mailing Address - Street 2:TARGET T-1187
Mailing Address - City:DANVERS
Mailing Address - State:MA
Mailing Address - Zip Code:01923-3653
Mailing Address - Country:US
Mailing Address - Phone:978-762-4439
Mailing Address - Fax:
Practice Address - Street 1:240 INDEPENDENCE WAY
Practice Address - Street 2:TARGET T-1187
Practice Address - City:DANVERS
Practice Address - State:MA
Practice Address - Zip Code:01923-3653
Practice Address - Country:US
Practice Address - Phone:978-762-4439
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-16
Last Update Date:2011-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA20825183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist