Healthcare Provider Details

I. General information

NPI: 1811304975
Provider Name (Legal Business Name): GREGORY PEDEN PHARM D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2014
Last Update Date: 07/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 LEM MORRISON AU PHARMACY
AUBURN AL
36849-0001
US

IV. Provider business mailing address

400 LEM MORRISON AU PHARMACY
AUBURN AL
36849-0001
US

V. Phone/Fax

Practice location:
  • Phone: 334-844-4641
  • Fax: 334-844-4969
Mailing address:
  • Phone: 334-844-4641
  • Fax: 334-844-4969

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number15784
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: