MEDICARE: CURTIS PEDEN JR.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183700000X	Pharmacy Technician	RPT49285	FL

General Provider Information

NPI Number	:	1922413483
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CURTIS PEDEN JR.

Provider Business Mailing Address
First Line	:	3854 NW ARCHER ST APT 102
Second Line	:
City	:	LAKE CITY
State	:	FL
Zip	:	32055-4813
Country	:	US
Telephone Number	:	386-466-2362
Fax Number	:

Provider Business Practice Location Address
First Line	:	3854 NW ARCHER ST APT 102
Second Line	:
City	:	LAKE CITY
State	:	FL
Zip	:	32055-4813
Country	:	US
Telephone Number	:	386-466-2362
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/24/2014
Last Update Date	:	06/24/2014

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