Healthcare Provider Details

I. General information

NPI: 1053743138
Provider Name (Legal Business Name): ABBY LEE PEACOCK PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2013
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10136 TWO NOTCH RD
COLUMBIA SC
29229-4389
US

IV. Provider business mailing address

510 DOVE PARK RD
COLUMBIA SC
29223-1413
US

V. Phone/Fax

Practice location:
  • Phone: 803-788-4141
  • Fax: 803-699-8868
Mailing address:
  • Phone: 478-231-8339
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number14285
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: