Provider Demographics
NPI:1841394897
Name:RICHARD LEIGHTON PEATMAN
Entity Type:Organization
Organization Name:RICHARD LEIGHTON PEATMAN
Other - Org Name:MEADOW VISTA PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:LEIGHTON PEATMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:530-878-7440
Mailing Address - Street 1:16893 PLACER HILLS RD
Mailing Address - Street 2:
Mailing Address - City:MEADOW VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:95722-9531
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:16893 PLACER HILLS RD
Practice Address - Street 2:
Practice Address - City:MEADOW VISTA
Practice Address - State:CA
Practice Address - Zip Code:95722-9531
Practice Address - Country:US
Practice Address - Phone:530-878-7440
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-12
Last Update Date:2016-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
CAPHY420613336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA420610Medicaid
1998848OtherPK