Healthcare Provider Details

I. General information

NPI: 1972589430
Provider Name (Legal Business Name): PEACE PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2005
Last Update Date: 04/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 S BUFFALO
CANTON TX
75103
US

IV. Provider business mailing address

300 S BUFFALO PO BOX 38
CANTON TX
75103
US

V. Phone/Fax

Practice location:
  • Phone: 903-567-4129
  • Fax: 903-567-6772
Mailing address:
  • Phone: 903-567-4129
  • Fax: 903-567-6772

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number01827
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MS. CINDY K TROGLIN
Title or Position: BILLING MGR MEDICARE MEDICAID SPE
Credential:
Phone: 903-567-4129