Provider Demographics
NPI:1629015912
Name:PELTON, RICHARD HUGHES (RPH,MS)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:HUGHES
Last Name:PELTON
Suffix:
Gender:M
Credentials:RPH,MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14309 HOMOSASSA ST
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33613-2058
Mailing Address - Country:US
Mailing Address - Phone:813-230-5655
Mailing Address - Fax:
Practice Address - Street 1:13300 BRUCE B DOWNS BLVD
Practice Address - Street 2:JAMES A HALEY VA
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612-3808
Practice Address - Country:US
Practice Address - Phone:813-972-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2007-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS22212183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPS22212OtherPHARMACY LICENSE