Provider Demographics
NPI:1255704391
Name:PATTERSON, PEGGY JO (RPH)
Entity type:Individual
Prefix:DR
First Name:PEGGY
Middle Name:JO
Last Name:PATTERSON
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1615 GRAND AVENUE PKWY
Mailing Address - Street 2:
Mailing Address - City:PFLUGERVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78660-2059
Mailing Address - Country:US
Mailing Address - Phone:512-377-1999
Mailing Address - Fax:512-252-2662
Practice Address - Street 1:1615 GRAND AVENUE PKWY
Practice Address - Street 2:
Practice Address - City:PFLUGERVILLE
Practice Address - State:TX
Practice Address - Zip Code:78660-2059
Practice Address - Country:US
Practice Address - Phone:512-377-1999
Practice Address - Fax:512-252-2662
Is Sole Proprietor?:No
Enumeration Date:2015-11-12
Last Update Date:2015-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX21386183500000X
HI624183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist