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General NPI Number Information
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NPI Number | 1528280807
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Entity Type | Individual
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Provider Name | JOHN CHARLES PEACOCK SR. RPH
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Gender | Male
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Dates
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Enumeration Date | 05/03/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 3621 US HWY 231 NORTH
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City | PANAMA CITY
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State | FL
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Zip | 32404
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Country | US
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Telephone | 850-914-0200
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Fax | 850-914-9125
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Provider Business Mailing Address
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Address Line | PO BOX 613
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City | BLOUNTSTOWN
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State | FL
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Zip | 32424-0613
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Country | US
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Telephone | 850-674-5756
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Fax | 850-914-9125
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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 | PS10385
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License Number State | FL
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