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General NPI Number Information
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NPI Number | 1255680849
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Entity Type | Individual
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Provider Name | WILL PECK PHARM.D.
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Gender | Male
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Dates
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Enumeration Date | 08/29/2012
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Last Update Date | 08/29/2012
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Provider Practice Location Address
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Address Line | 3101 JEFFERSON DAVIS HWY
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City | ALEXANDRIA
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State | VA
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Zip | 22305-3042
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Country | US
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Telephone | 703-706-3852
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Fax |
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Provider Business Mailing Address
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Address Line | 4801 KENMORE AVENUE #622
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City | ALEXANDRIA
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State | VA
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Zip | 22304
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Country | US
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Telephone | 734-678-1965
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 0202211730
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 20923
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License Number State | MD
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