Provider Demographics
NPI:1457886525
Name:PECKENS, BREECI LAINA (PHARMD)
Entity Type:Individual
Prefix:
First Name:BREECI
Middle Name:LAINA
Last Name:PECKENS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:YORKVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43971-1202
Mailing Address - Country:US
Mailing Address - Phone:740-359-3124
Mailing Address - Fax:
Practice Address - Street 1:800 W COSHOCTON ST
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:OH
Practice Address - Zip Code:43031-8904
Practice Address - Country:US
Practice Address - Phone:740-966-8310
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-26
Last Update Date:2017-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03232999183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist