Provider Demographics
NPI:1942581053
Name:PETER, JEOBU (MPHARM)
Entity Type:Individual
Prefix:
First Name:JEOBU
Middle Name:
Last Name:PETER
Suffix:
Gender:M
Credentials:MPHARM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 NASHVILLE PIKE STE 101
Mailing Address - Street 2:
Mailing Address - City:GALLATIN
Mailing Address - State:TN
Mailing Address - Zip Code:37066-4592
Mailing Address - Country:US
Mailing Address - Phone:615-461-7078
Mailing Address - Fax:
Practice Address - Street 1:710 NASHVILLE PIKE STE 101
Practice Address - Street 2:
Practice Address - City:GALLATIN
Practice Address - State:TN
Practice Address - Zip Code:37066-4592
Practice Address - Country:US
Practice Address - Phone:615-461-7078
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-01
Last Update Date:2022-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD19981183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist