Provider Demographics
NPI:1053790865
Name:PERRIN, JEFFREY ARNOLD
Entity type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:ARNOLD
Last Name:PERRIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:JEFFREY
Other - Middle Name:ARNOLD
Other - Last Name:PERRIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RPH
Mailing Address - Street 1:3205 W VALLEY VIEW DR
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MI
Mailing Address - Zip Code:49085-9407
Mailing Address - Country:US
Mailing Address - Phone:269-556-1277
Mailing Address - Fax:
Practice Address - Street 1:3205 W VALLEY VIEW DR
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MI
Practice Address - Zip Code:49085-9407
Practice Address - Country:US
Practice Address - Phone:269-556-1277
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-26
Last Update Date:2015-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302024793183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist