Provider Demographics
NPI:1205240116
Name:PECK, JAMES ERNEST (PH)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:ERNEST
Last Name:PECK
Suffix:
Gender:M
Credentials:PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7227 PONTIAC CIR
Mailing Address - Street 2:
Mailing Address - City:CHANHASSEN
Mailing Address - State:MN
Mailing Address - Zip Code:55317-9454
Mailing Address - Country:US
Mailing Address - Phone:952-474-5071
Mailing Address - Fax:952-474-3079
Practice Address - Street 1:7227 PONTIAC CIR
Practice Address - Street 2:
Practice Address - City:CHANHASSEN
Practice Address - State:MN
Practice Address - Zip Code:55317-9454
Practice Address - Country:US
Practice Address - Phone:952-474-5071
Practice Address - Fax:952-474-3079
Is Sole Proprietor?:No
Enumeration Date:2014-06-18
Last Update Date:2014-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN110629183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist