Healthcare Provider Details

I. General information

NPI: 1205357514
Provider Name (Legal Business Name): JUSTIN PEAK
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2017
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1428 MARION WALDO RD
MARION OH
43302-7422
US

IV. Provider business mailing address

3269 COUNTY ROAD 125
CARDINGTON OH
43315-9517
US

V. Phone/Fax

Practice location:
  • Phone: 740-386-2321
  • Fax:
Mailing address:
  • Phone: 419-768-4422
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number03233020
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: