Provider Demographics
NPI:1689976045
Name:PESHEK, CHRISTOPHER T (PHARMD, BSPS)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:T
Last Name:PESHEK
Suffix:
Gender:M
Credentials:PHARMD, BSPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8500 MENTOR AVE
Mailing Address - Street 2:
Mailing Address - City:MENTOR
Mailing Address - State:OH
Mailing Address - Zip Code:44060-5819
Mailing Address - Country:US
Mailing Address - Phone:440-255-0040
Mailing Address - Fax:440-255-2591
Practice Address - Street 1:8500 MENTOR AVE
Practice Address - Street 2:
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-5819
Practice Address - Country:US
Practice Address - Phone:440-255-0040
Practice Address - Fax:440-255-2591
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-17
Last Update Date:2010-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03329003183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist