Provider Demographics
NPI:1568866341
Name:PECK, JOEL
Entity Type:Individual
Prefix:
First Name:JOEL
Middle Name:
Last Name:PECK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:888 SOUTH SADDLECREEK RD
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68106
Mailing Address - Country:US
Mailing Address - Phone:402-556-5600
Mailing Address - Fax:402-554-7304
Practice Address - Street 1:888 SOUTH SADDLECREEK RD
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68106
Practice Address - Country:US
Practice Address - Phone:402-556-5600
Practice Address - Fax:402-554-7304
Is Sole Proprietor?:No
Enumeration Date:2014-10-22
Last Update Date:2014-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE11533183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist