Provider Demographics
NPI:1962007781
Name:PECKHAM, MEGAN MIRANDA (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:MEGAN
Middle Name:MIRANDA
Last Name:PECKHAM
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1270 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36301-1414
Mailing Address - Country:US
Mailing Address - Phone:334-793-2372
Mailing Address - Fax:334-793-6568
Practice Address - Street 1:1270 W MAIN ST
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36301-1414
Practice Address - Country:US
Practice Address - Phone:334-793-2372
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-01
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL16639183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist