MEDICARE: MR. MARK A. PELTON RPH

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
1	183500000X	Pharmacist	10388	WI

General Provider Information

NPI Number	:	1033115787
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MARK A. PELTON RPH

Provider Business Mailing Address
First Line	:	218 MICHIGAN CT
Second Line	:
City	:	RACINE
State	:	WI
Zip	:	53402-3883
Country	:	US
Telephone Number	:	262-687-5108
Fax Number	:

Provider Business Practice Location Address
First Line	:	3801 SPRING ST
Second Line	:
City	:	RACINE
State	:	WI
Zip	:	53405-1667
Country	:	US
Telephone Number	:	262-687-5108
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/27/2005
Last Update Date	:	07/08/2007

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