Provider Demographics
NPI:1750663050
Name:PEPLOS, PETER JAMES
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:JAMES
Last Name:PEPLOS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6622 ROLLING HEDGE LN
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61108-5625
Mailing Address - Country:US
Mailing Address - Phone:815-227-0819
Mailing Address - Fax:
Practice Address - Street 1:6622 ROLLING HEDGE LN
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61108-5625
Practice Address - Country:US
Practice Address - Phone:815-227-0819
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-13
Last Update Date:2011-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051039702183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist