Provider Demographics
NPI:1700439452
Name:PEACOCK, KATHRYN ANDERSON (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:ANDERSON
Last Name:PEACOCK
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:KATHRYN
Other - Middle Name:NICOLE
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:1025 CORTLAND VLY
Mailing Address - Street 2:
Mailing Address - City:DUNCAN
Mailing Address - State:SC
Mailing Address - Zip Code:29334-7906
Mailing Address - Country:US
Mailing Address - Phone:864-357-4007
Mailing Address - Fax:
Practice Address - Street 1:307 N BROAD ST
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:SC
Practice Address - Zip Code:29325-2305
Practice Address - Country:US
Practice Address - Phone:864-938-3933
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-22
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC42118183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist