Provider Demographics
NPI:1396892493
Name:WILLCUTS, PEGGY S (REGISTERED PHARMACIS)
Entity type:Individual
Prefix:MISS
First Name:PEGGY
Middle Name:S
Last Name:WILLCUTS
Suffix:
Gender:F
Credentials:REGISTERED PHARMACIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:ROSEBUD IHS HOSPITAL
Mailing Address - Street 2:SOLDIER CREEK ROAD
Mailing Address - City:ROSEBUD
Mailing Address - State:SD
Mailing Address - Zip Code:57570-0400
Mailing Address - Country:US
Mailing Address - Phone:605-747-3245
Mailing Address - Fax:605-747-5348
Practice Address - Street 1:ROSEBUD IHS HOSPITAL
Practice Address - Street 2:SOLDIER CREEK ROAD
Practice Address - City:ROSEBUD
Practice Address - State:SD
Practice Address - Zip Code:57570-0400
Practice Address - Country:US
Practice Address - Phone:605-747-3245
Practice Address - Fax:605-747-5348
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD5358183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist