Provider Demographics
NPI:1669788071
Name:PEEBLES, MICHAEL (RPH)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:
Last Name:PEEBLES
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 1:3616 E RAY RD
Mailing Address - Street 2:PHARMACY
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85044-7114
Mailing Address - Country:US
Mailing Address - Phone:480-706-0609
Mailing Address - Fax:480-706-6078
Practice Address - Street 1:3616 E RAY RD
Practice Address - Street 2:PHARMACY
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85044-7114
Practice Address - Country:US
Practice Address - Phone:480-706-0609
Practice Address - Fax:480-706-6078
Is Sole Proprietor?:No
Enumeration Date:2010-08-23
Last Update Date:2010-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS12084183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist