Provider Demographics
NPI:1750722625
Name:PEIGHTAL, THOMAS DEVON (PHARMD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:DEVON
Last Name:PEIGHTAL
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2401 E NORTH ST
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-1401
Mailing Address - Country:US
Mailing Address - Phone:864-244-1851
Mailing Address - Fax:864-244-3430
Practice Address - Street 1:2401 E NORTH ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-1401
Practice Address - Country:US
Practice Address - Phone:864-244-1851
Practice Address - Fax:864-244-3430
Is Sole Proprietor?:No
Enumeration Date:2013-07-08
Last Update Date:2013-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC12213183500000X
MD19651183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC12213OtherSTATE PHARMACIST LICENSE
MD19651OtherMARYLAND PHARMACIST LICENSE