Provider Demographics
NPI:1972051050
Name:PECKENS, ROBERT DOUGLAS JR (RPH)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:DOUGLAS
Last Name:PECKENS
Suffix:JR
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:264 S HOLLYWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:STEUBENVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43952-2422
Mailing Address - Country:US
Mailing Address - Phone:740-266-2894
Mailing Address - Fax:740-266-2885
Practice Address - Street 1:264 S HOLLYWOOD BLVD
Practice Address - Street 2:
Practice Address - City:STEUBENVILLE
Practice Address - State:OH
Practice Address - Zip Code:43952-2422
Practice Address - Country:US
Practice Address - Phone:740-266-2894
Practice Address - Fax:740-266-2885
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-16
Last Update Date:2016-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03114842183500000X
WVRP0004805183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist