Provider Demographics
NPI:1558805572
Name:PECKENS, JUDITH (RPH)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:
Last Name:PECKENS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 THREE SPRINGS DR
Mailing Address - Street 2:
Mailing Address - City:WEIRTON
Mailing Address - State:WV
Mailing Address - Zip Code:26062-3815
Mailing Address - Country:US
Mailing Address - Phone:304-723-0570
Mailing Address - Fax:
Practice Address - Street 1:250 THREE SPRINGS DR
Practice Address - Street 2:
Practice Address - City:WEIRTON
Practice Address - State:WV
Practice Address - Zip Code:26062-3815
Practice Address - Country:US
Practice Address - Phone:304-723-0570
Practice Address - Fax:847-396-2592
Is Sole Proprietor?:No
Enumeration Date:2016-12-09
Last Update Date:2016-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVRP0003494183500000X
OH03213216183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist