Healthcare Provider Details

I. General information

NPI: 1467749077
Provider Name (Legal Business Name): MEREDITH CUNDEY PECKEL PHARM D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2011
Last Update Date: 07/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1647 GORDON HWY
AUGUSTA GA
30906-2297
US

IV. Provider business mailing address

239 DIXON CT
EVANS GA
30809-4302
US

V. Phone/Fax

Practice location:
  • Phone: 706-738-5451
  • Fax:
Mailing address:
  • Phone: 706-860-4991
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number022620
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: