Provider Demographics
NPI:1275744567
Name:P.E.B. INC
Entity Type:Organization
Organization Name:P.E.B. INC
Other - Org Name:THE COMPOUNDING SHOP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT / PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:BURT
Authorized Official - Middle Name:L
Authorized Official - Last Name:PATTERSON
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:228-875-0158
Mailing Address - Street 1:1121 OCEAN SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:OCEAN SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:39564-3421
Mailing Address - Country:US
Mailing Address - Phone:228-875-0158
Mailing Address - Fax:228-875-4546
Practice Address - Street 1:1121 OCEAN SPRINGS RD
Practice Address - Street 2:
Practice Address - City:OCEAN SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:39564-3421
Practice Address - Country:US
Practice Address - Phone:228-875-0158
Practice Address - Fax:228-875-4546
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-25
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy