Provider Demographics
NPI:1972931251
Name:CHAMPION, PETER
Entity Type:Individual
Prefix:MR
First Name:PETER
Middle Name:
Last Name:CHAMPION
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 LODGE RD
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27889-3131
Mailing Address - Country:US
Mailing Address - Phone:757-705-5044
Mailing Address - Fax:
Practice Address - Street 1:454 US HIGHWAY 64 E
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:NC
Practice Address - Zip Code:27962-9593
Practice Address - Country:US
Practice Address - Phone:252-793-9036
Practice Address - Fax:252-793-1006
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-23
Last Update Date:2013-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC15680183500000X
VA0202005045183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist