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NPI Code Detail

MEDICARE: SHIRLEY ROSE PELTRO PHARM.D

MEDICARE: SHIRLEY ROSE PELTRO PHARM.D
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacistRPH023804GA

General Provider Information

NPI Number : 1003199050
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHIRLEY ROSE PELTRO PHARM.D
Provider Business Mailing Address
First Line : 355 SIMONTON CREST DR
Second Line :
City : LAWRENCEVILLE
State : GA
Zip : 30045-3513
Country : US
Telephone Number : 718-208-0574
Fax Number :
Provider Business Practice Location Address
First Line : 4398 ATLANTA HWY
Second Line :
City : LOGANVILLE
State : GA
Zip : 30052-7314
Country : US
Telephone Number : 678-639-0213
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/26/2011
Last Update Date : 09/26/2011

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