Provider Demographics
NPI:1639892334
Name:DURU, PEACE AMARACHI
Entity Type:Individual
Prefix:
First Name:PEACE
Middle Name:AMARACHI
Last Name:DURU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4763 BUCKBOARD WAY
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:CA
Mailing Address - Zip Code:94803-3818
Mailing Address - Country:US
Mailing Address - Phone:918-630-4951
Mailing Address - Fax:
Practice Address - Street 1:4500 MACDONALD AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:CA
Practice Address - Zip Code:94805-2307
Practice Address - Country:US
Practice Address - Phone:510-253-1001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-19
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA855501835P2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
1386806834OtherCVS PHARMACY