Provider Demographics
NPI:1093021560
Name:PEACHTREE INC
Entity Type:Organization
Organization Name:PEACHTREE INC
Other - Org Name:PEACHTREE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SAUNDRIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-203-5700
Mailing Address - Street 1:9896 BISSONNET ST
Mailing Address - Street 2:SUITE 126
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77036-8104
Mailing Address - Country:US
Mailing Address - Phone:832-203-5700
Mailing Address - Fax:832-203-5454
Practice Address - Street 1:9896 BISSONNET ST STE 126
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036-8152
Practice Address - Country:US
Practice Address - Phone:832-203-5700
Practice Address - Fax:832-203-5454
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-23
Last Update Date:2011-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX273913336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
5902879OtherNCPDP PROVIDER IDENTIFICATION NUMBER