Healthcare Provider Details

I. General information

NPI: 1639170053
Provider Name (Legal Business Name): STEPHANIE PECK-WHEELER PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3851 ROSECRANS ST MS P-507-J
SAN DIEGO CA
92110-3115
US

IV. Provider business mailing address

3944 DEL MAR AVE
SAN DIEGO CA
92107-3735
US

V. Phone/Fax

Practice location:
  • Phone: 619-692-8037
  • Fax: 619-692-6696
Mailing address:
  • Phone: 619-225-0042
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1300X
TaxonomyPsychiatric Pharmacist
License Number39114
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: