Provider Demographics
NPI:1295879757
Name:PEACOCK, JOSEPH PAUL (RPH)
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:PAUL
Last Name:PEACOCK
Suffix:
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 1:9540 OAK HOLLOW TRL
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32309-9637
Mailing Address - Country:US
Mailing Address - Phone:850-878-8412
Mailing Address - Fax:
Practice Address - Street 1:111 S MAGNOLIA DR STE 39
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32301-2958
Practice Address - Country:US
Practice Address - Phone:850-656-3414
Practice Address - Fax:850-877-5916
Is Sole Proprietor?:No
Enumeration Date:2007-02-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS 16929183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPS 16929OtherPHARMACY LICENSE NUMBER