Provider Demographics
NPI:1063446664
Name:PECK, CHARLES CURTIS (RPH)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:CURTIS
Last Name:PECK
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 OAKWOOD DR
Mailing Address - Street 2:
Mailing Address - City:PHILIPSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:16866-8700
Mailing Address - Country:US
Mailing Address - Phone:814-343-4766
Mailing Address - Fax:814-343-4754
Practice Address - Street 1:US ROUTE 220
Practice Address - Street 2:
Practice Address - City:TIPTON
Practice Address - State:PA
Practice Address - Zip Code:16684
Practice Address - Country:US
Practice Address - Phone:814-684-7979
Practice Address - Fax:814-684-7647
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP030777L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist