Provider Demographics
NPI:1063008191
Name:PECK, VINCENT
Entity Type:Individual
Prefix:
First Name:VINCENT
Middle Name:
Last Name:PECK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 GRANDVILLE DR
Mailing Address - Street 2:
Mailing Address - City:SWOYERSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18704-1251
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:70 GRANDVILLE DR
Practice Address - Street 2:
Practice Address - City:SWOYERSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18704-1251
Practice Address - Country:US
Practice Address - Phone:570-881-1074
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-13
Last Update Date:2020-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP4486381835P2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care