Provider Demographics
NPI:1770097677
Name:PEACOCK, YVETTE ALMA (PHARMD)
Entity type:Individual
Prefix:
First Name:YVETTE
Middle Name:ALMA
Last Name:PEACOCK
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 1:1226 SW 28TH ST
Mailing Address - Street 2:
Mailing Address - City:TROUTDALE
Mailing Address - State:OR
Mailing Address - Zip Code:97060-1818
Mailing Address - Country:US
Mailing Address - Phone:360-241-8398
Mailing Address - Fax:
Practice Address - Street 1:411 THREE RIVERS DR
Practice Address - Street 2:
Practice Address - City:KELSO
Practice Address - State:WA
Practice Address - Zip Code:98626-3126
Practice Address - Country:US
Practice Address - Phone:360-636-5430
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-30
Last Update Date:2017-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60796754183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist