Provider Demographics
NPI:1326321191
Name:PEACOCK, CHRISTY MCPHERSON (PHARMD)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTY
Middle Name:MCPHERSON
Last Name:PEACOCK
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:153 BEVINGTON LN
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30188-5420
Mailing Address - Country:US
Mailing Address - Phone:678-445-4906
Mailing Address - Fax:
Practice Address - Street 1:2988 SHALLOWFORD RD
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30066-3033
Practice Address - Country:US
Practice Address - Phone:678-560-1871
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-27
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA20504183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist