=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841394897
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RICHARD LEIGHTON PEATMAN
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/12/2006
-----------------------------------------------------
Last Update Date | 11/02/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 16893 PLACER HILLS RD
-----------------------------------------------------
City | MEADOW VISTA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95722-9531
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 530-878-7440
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 16893 PLACER HILLS RD
-----------------------------------------------------
City | MEADOW VISTA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95722-9531
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | RICHARD LEIGHTON PEATMAN
-----------------------------------------------------
Credential | PHARM.D.
-----------------------------------------------------
Telephone | 530-878-7440
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | PHY42061
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------