Healthcare Provider Details

I. General information

NPI: 1508469230
Provider Name (Legal Business Name): REBECCA LYNN PEEK RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2020
Last Update Date: 11/17/2020
Certification Date: 11/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1916 GAULT AVE N
FORT PAYNE AL
35967-3418
US

IV. Provider business mailing address

861 COUNTY ROAD 260
PISGAH AL
35765-7346
US

V. Phone/Fax

Practice location:
  • Phone: 256-845-2004
  • Fax: 256-845-7839
Mailing address:
  • Phone: 256-605-9339
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number13276
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: