Provider Demographics
NPI:1790779239
Name:PEEK, CAROL A
Entity Type:Individual
Prefix:DR
First Name:CAROL
Middle Name:A
Last Name:PEEK
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 1:9312 S GRACE AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73159-7100
Mailing Address - Country:US
Mailing Address - Phone:405-271-6446
Mailing Address - Fax:405-271-6447
Practice Address - Street 1:825 NE 10TH ST
Practice Address - Street 2:#2200
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73104-5417
Practice Address - Country:US
Practice Address - Phone:405-271-6446
Practice Address - Fax:405-271-6447
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-09
Last Update Date:2008-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK10225183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist