Provider Demographics
NPI:1609148246
Name:PULEO, PETER CHARLES (RPH)
Entity Type:Individual
Prefix:MR
First Name:PETER
Middle Name:CHARLES
Last Name:PULEO
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 CREEKSIDE PL
Mailing Address - Street 2:
Mailing Address - City:DELAVAN
Mailing Address - State:WI
Mailing Address - Zip Code:53115-2129
Mailing Address - Country:US
Mailing Address - Phone:262-725-6238
Mailing Address - Fax:
Practice Address - Street 1:5510 HOWARD ST
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077-2620
Practice Address - Country:US
Practice Address - Phone:847-588-7170
Practice Address - Fax:847-588-7060
Is Sole Proprietor?:No
Enumeration Date:2012-01-28
Last Update Date:2012-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI10756-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist