Provider Demographics
NPI:1891080461
Name:PEETE, ROBERT DOUGLAS (DOCTOR OF PHARMACY)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:DOUGLAS
Last Name:PEETE
Suffix:
Gender:M
Credentials:DOCTOR OF PHARMACY
Other - Prefix:DR
Other - First Name:ROBERT
Other - Middle Name:DOUGLAS
Other - Last Name:PEETE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:32926
Mailing Address - Street 1:2169 W REDONDO BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90247-3625
Mailing Address - Country:US
Mailing Address - Phone:310-515-3783
Mailing Address - Fax:310-515-3783
Practice Address - Street 1:2169 W REDONDO BEACH BLVD
Practice Address - Street 2:
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90247-3625
Practice Address - Country:US
Practice Address - Phone:310-515-3783
Practice Address - Fax:310-515-3783
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-12
Last Update Date:2011-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32926183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA476060OtherBOARD OF PHARMACY LICENSE