Provider Demographics
NPI:1184786105
Name:TURNER, PETER IAN (PHARMACIST)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:IAN
Last Name:TURNER
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2901 W KIRBY AVE
Mailing Address - Street 2:
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61821-5301
Mailing Address - Country:US
Mailing Address - Phone:217-351-3108
Mailing Address - Fax:217-351-3128
Practice Address - Street 1:2901 W KIRBY AVE
Practice Address - Street 2:
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61821-5301
Practice Address - Country:US
Practice Address - Phone:217-351-3108
Practice Address - Fax:217-351-3128
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-15
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051038036183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL051038036OtherREGISTER PHARMACIST