Active NPI
Mary Jo Perdue, PHARMACIST
- Pharmacist
- Wheelersburg, OH
National Provider Identifier
1639276264
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 12057
- Practice address
- 313 Center St
Wheelersburg, OH 45694-1706 - Phone
- (740) 574-2874
- Fax
- (740) 574-8883
- NPI assigned
- Sep 17, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 12057 | OH | Primary |
Addresses
Primary practice location
313 Center St
Wheelersburg, OH 45694-1706
Mailing address
313 Center St
Wheelersburg, OH 45694-1706
Phone (740) 574-2874
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 12057 | Other | OH | PHARMACIST |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12057 | OH | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Stakers Drugs East Inc | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Community/Retail Pharmacy
- Wheelersburg, OH
- NPI 1811938269
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158451200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1639276264",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "313 CENTER ST",
"city": "WHEELERSBURG",
"state": "OH",
"postal_code": "456941706",
"telephone_number": "740-574-2874",
"fax_number": "740-574-8883"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "313 CENTER ST",
"city": "WHEELERSBURG",
"state": "OH",
"postal_code": "456941706",
"telephone_number": "740-574-2874",
"fax_number": "740-574-8883"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PERDUE",
"first_name": "MARY",
"middle_name": "JO",
"name_prefix": "Mrs.",
"credential": "PHARMACIST",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-09-17",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "OH",
"license": "12057",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PHARMACIST",
"identifier": "12057",
"state": "OH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Wheelersburg, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.