Provider Demographics
NPI:1811304975
Name:PEDEN, GREGORY (PHARM D)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:
Last Name:PEDEN
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 LEM MORRISON
Mailing Address - Street 2:AU PHARMACY
Mailing Address - City:AUBURN
Mailing Address - State:AL
Mailing Address - Zip Code:36849-0001
Mailing Address - Country:US
Mailing Address - Phone:334-844-4641
Mailing Address - Fax:334-844-4969
Practice Address - Street 1:400 LEM MORRISON
Practice Address - Street 2:AU PHARMACY
Practice Address - City:AUBURN
Practice Address - State:AL
Practice Address - Zip Code:36849-0001
Practice Address - Country:US
Practice Address - Phone:334-844-4641
Practice Address - Fax:334-844-4969
Is Sole Proprietor?:No
Enumeration Date:2014-07-21
Last Update Date:2014-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL15784183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist