Provider Demographics
NPI:1225621881
Name:PELATE, ALBERT (RPH)
Entity Type:Individual
Prefix:MR
First Name:ALBERT
Middle Name:
Last Name:PELATE
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 1:2770 MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:GRANITE CITY
Mailing Address - State:IL
Mailing Address - Zip Code:62040-3607
Mailing Address - Country:US
Mailing Address - Phone:618-451-8001
Mailing Address - Fax:618-451-8015
Practice Address - Street 1:2770 MADISON AVE
Practice Address - Street 2:
Practice Address - City:GRANITE CITY
Practice Address - State:IL
Practice Address - Zip Code:62040-3607
Practice Address - Country:US
Practice Address - Phone:618-451-8001
Practice Address - Fax:618-451-8015
Is Sole Proprietor?:No
Enumeration Date:2021-02-15
Last Update Date:2021-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.032746183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist