=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881722189
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DON PEELER PHARMACY INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/01/2007
-----------------------------------------------------
Last Update Date | 09/07/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 127 E NORTH ST
-----------------------------------------------------
City | MADISONVILLE
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 42431-1628
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 270-821-5491
-----------------------------------------------------
Fax | 270-825-3924
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 127 E NORTH ST
-----------------------------------------------------
City | MADISONVILLE
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 42431-1628
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 270-821-5491
-----------------------------------------------------
Fax | 270-825-3924
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MR. DALE O GUNKEL
-----------------------------------------------------
Credential | RPH
-----------------------------------------------------
Telephone | 270-821-5491
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number | 001312
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------