Provider Demographics
NPI:1851784946
Name:PEACOCK, ALEXSANDER TEWELDE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ALEXSANDER
Middle Name:TEWELDE
Last Name:PEACOCK
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:ALEXSANDER
Other - Middle Name:
Other - Last Name:TEWELDE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:28145 WALKER RD S
Mailing Address - Street 2:
Mailing Address - City:WALKER
Mailing Address - State:LA
Mailing Address - Zip Code:70785-6027
Mailing Address - Country:US
Mailing Address - Phone:225-791-5640
Mailing Address - Fax:225-791-5620
Practice Address - Street 1:7515 PERKINS RD
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-4381
Practice Address - Country:US
Practice Address - Phone:225-769-6084
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-12
Last Update Date:2023-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA019734183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist