Provider Demographics
NPI:1073713210
Name:PECK, GEORGE DENNIS (RPH)
Entity Type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:DENNIS
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 1:1457 VANCIL ST
Mailing Address - Street 2:
Mailing Address - City:FORTUNA
Mailing Address - State:CA
Mailing Address - Zip Code:95540-1520
Mailing Address - Country:US
Mailing Address - Phone:707-725-3190
Mailing Address - Fax:
Practice Address - Street 1:113 MAIN ST.
Practice Address - Street 2:SUITE D
Practice Address - City:SCOTIA
Practice Address - State:CA
Practice Address - Zip Code:95565
Practice Address - Country:US
Practice Address - Phone:707-764-3591
Practice Address - Fax:707-764-3797
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-24
Last Update Date:2007-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA28543183500000X
OR5865183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist