Provider Demographics
NPI:1275690133
Name:PELTZ, BRIAN JOHN (RPH)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:JOHN
Last Name:PELTZ
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4700 SCHAEFER RD
Mailing Address - Street 2:SUITE 340
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-3655
Mailing Address - Country:US
Mailing Address - Phone:313-827-5565
Mailing Address - Fax:313-429-5165
Practice Address - Street 1:4700 SCHAEFER RD
Practice Address - Street 2:SUITE 340
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-3655
Practice Address - Country:US
Practice Address - Phone:313-827-5565
Practice Address - Fax:313-429-5165
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2013-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302025437183500000X
IL051.294009183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist