Provider Demographics
NPI:1730781659
Name:PERDEW, HARRISON AUSTIN (PHARMD)
Entity type:Individual
Prefix:
First Name:HARRISON
Middle Name:AUSTIN
Last Name:PERDEW
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1215 W FOXWOOD DR
Mailing Address - Street 2:
Mailing Address - City:RAYMORE
Mailing Address - State:MO
Mailing Address - Zip Code:64083-8301
Mailing Address - Country:US
Mailing Address - Phone:816-318-8022
Mailing Address - Fax:816-331-3253
Practice Address - Street 1:1215 W FOXWOOD DR
Practice Address - Street 2:
Practice Address - City:RAYMORE
Practice Address - State:MO
Practice Address - Zip Code:64083-8301
Practice Address - Country:US
Practice Address - Phone:816-318-8022
Practice Address - Fax:816-331-3253
Is Sole Proprietor?:No
Enumeration Date:2020-11-16
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-15833183500000X
MO2017037464183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist