Provider Demographics
NPI:1669689345
Name:PEEBLES, CATHERINE B (RPH)
Entity Type:Individual
Prefix:MRS
First Name:CATHERINE
Middle Name:B
Last Name:PEEBLES
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 1:4525 WINTHROP AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29206-3029
Mailing Address - Country:US
Mailing Address - Phone:803-217-9712
Mailing Address - Fax:803-217-9717
Practice Address - Street 1:1426 MAIN ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-5804
Practice Address - Country:US
Practice Address - Phone:803-217-9712
Practice Address - Fax:803-217-9717
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC009015183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC009015OtherSTATE LISCENCE NUMBER