Provider Demographics
NPI:1710471990
Name:ALLEGRE, PETER C (RPH)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:C
Last Name:ALLEGRE
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:PO BOX 25
Mailing Address - Street 2:
Mailing Address - City:LEBO
Mailing Address - State:KS
Mailing Address - Zip Code:66856-0025
Mailing Address - Country:US
Mailing Address - Phone:620-256-6122
Mailing Address - Fax:620-256-6117
Practice Address - Street 1:6 W BROADWAY ST
Practice Address - Street 2:
Practice Address - City:LEBO
Practice Address - State:KS
Practice Address - Zip Code:66856-9709
Practice Address - Country:US
Practice Address - Phone:620-256-6122
Practice Address - Fax:620-256-6117
Is Sole Proprietor?:No
Enumeration Date:2018-06-20
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-10176183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist