Provider Demographics
NPI:1699742627
Name:PERKINSON, JAMES WILSON (RPH)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:WILSON
Last Name:PERKINSON
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 1:243 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RADFORD
Mailing Address - State:VA
Mailing Address - Zip Code:24141-1584
Mailing Address - Country:US
Mailing Address - Phone:540-639-3996
Mailing Address - Fax:540-731-4852
Practice Address - Street 1:243 W MAIN ST
Practice Address - Street 2:
Practice Address - City:RADFORD
Practice Address - State:VA
Practice Address - Zip Code:24141-1584
Practice Address - Country:US
Practice Address - Phone:540-639-3996
Practice Address - Fax:540-731-4852
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202004997183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0202004997OtherSTATE LICENSE NUMBER