Provider Demographics
NPI:1275520561
Name:PEFFER, JACK
Entity Type:Individual
Prefix:MR
First Name:JACK
Middle Name:
Last Name:PEFFER
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 1:3589 BRODHEAD RD
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:MONACA
Mailing Address - State:PA
Mailing Address - Zip Code:15061-3138
Mailing Address - Country:US
Mailing Address - Phone:724-774-2990
Mailing Address - Fax:
Practice Address - Street 1:3589 BRODHEAD RD
Practice Address - Street 2:SUITE 1A
Practice Address - City:MONACA
Practice Address - State:PA
Practice Address - Zip Code:15061-3138
Practice Address - Country:US
Practice Address - Phone:724-774-2990
Practice Address - Fax:724-774-6832
Is Sole Proprietor?:No
Enumeration Date:2005-10-01
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP045878L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist