Provider Demographics
NPI:1962784850
Name:PERRY, LATEEFAH KAMYNAE
Entity type:Individual
Prefix:DR
First Name:LATEEFAH
Middle Name:KAMYNAE
Last Name:PERRY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2126 NALL ST
Mailing Address - Street 2:
Mailing Address - City:PORT NECHES
Mailing Address - State:TX
Mailing Address - Zip Code:77651-3716
Mailing Address - Country:US
Mailing Address - Phone:409-727-1426
Mailing Address - Fax:
Practice Address - Street 1:2126 NALL ST
Practice Address - Street 2:
Practice Address - City:PORT NECHES
Practice Address - State:TX
Practice Address - Zip Code:77651-3716
Practice Address - Country:US
Practice Address - Phone:409-727-1426
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-15
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX47328183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist