Provider Demographics
NPI:1801295688
Name:EA, PETER (PHARMD)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:
Last Name:EA
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 1:4055 EVERGREEN VILLAGE SQ
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95135-1748
Mailing Address - Country:US
Mailing Address - Phone:408-826-0341
Mailing Address - Fax:408-826-0342
Practice Address - Street 1:4055 EVERGREEN VILLAGE SQ
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95135-1748
Practice Address - Country:US
Practice Address - Phone:408-826-0341
Practice Address - Fax:408-826-0342
Is Sole Proprietor?:No
Enumeration Date:2014-08-18
Last Update Date:2014-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49868183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist