Provider Demographics
NPI:1407447436
Name:PEAKE, PURVI (PHARMD)
Entity Type:Individual
Prefix:
First Name:PURVI
Middle Name:
Last Name:PEAKE
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 1:7966 LOVERS LN
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:MI
Mailing Address - Zip Code:49002-4446
Mailing Address - Country:US
Mailing Address - Phone:269-492-7150
Mailing Address - Fax:269-492-9669
Practice Address - Street 1:7966 LOVERS LN
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:MI
Practice Address - Zip Code:49002-4446
Practice Address - Country:US
Practice Address - Phone:269-492-7150
Practice Address - Fax:269-492-9669
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-02
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302033907183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist