Provider Demographics
NPI:1851603518
Name:PEAK, HEDELIZA T (RPH)
Entity Type:Individual
Prefix:MRS
First Name:HEDELIZA
Middle Name:T
Last Name:PEAK
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7601 GRANBY ST
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23505-2508
Mailing Address - Country:US
Mailing Address - Phone:757-489-1157
Mailing Address - Fax:757-489-2540
Practice Address - Street 1:7601 GRANBY ST
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23505-2508
Practice Address - Country:US
Practice Address - Phone:757-489-1157
Practice Address - Fax:757-489-2540
Is Sole Proprietor?:No
Enumeration Date:2010-07-11
Last Update Date:2010-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202010122183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist