MEDICARE: MR. MICHAEL PEEBLES 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	S12084	AZ

General Provider Information

NPI Number	:	1669788071
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MICHAEL PEEBLES RPH

Provider Business Mailing Address
First Line	:	3616 E RAY RD
Second Line	:	PHARMACY
City	:	PHOENIX
State	:	AZ
Zip	:	85044-7114
Country	:	US
Telephone Number	:	480-706-0609
Fax Number	:	480-706-6078

Provider Business Practice Location Address
First Line	:	3616 E RAY RD
Second Line	:	PHARMACY
City	:	PHOENIX
State	:	AZ
Zip	:	85044-7114
Country	:	US
Telephone Number	:	480-706-0609
Fax Number	:	480-706-6078

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

Provider Enumeration Date	:	08/23/2010
Last Update Date	:	08/23/2010

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