# PEACOCK PHARMACY LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Peacock Pharmacy LLC
- **Organization subpart:** No

## Provider details

- **NPI number:** 1699086546
- **Authorized official:** ADAM WELLINGTON (PRESIDENT)
- **Authorized official phone:** (423) 547-3224

## Contact information

- **Practice address:** 8147 WARREN H ABERNATHY HWY, SPARTANBURG, SC 29301-2451
- **Practice address phone:** (864) 587-5707
- **Mailing address:** 1201 HWY 19E BYASS, SUITE 3, ELLIZABETHTON, TN 37649
- **Mailing address phone:** (423) 547-3224
- **Mailing address fax:** (800) 419-1565

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | NULL | — |
| 333600000X | Pharmacy | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | — | NULL | Yes |
| 3336M0002X | Mail Order Pharmacy | — | NULL | — |

## Other

- **Enumeration date:** 06/25/2010
- **Last updated:** 07/16/2010

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 4229731 | NCPDP PROVIDER IDENTIFICATION NUMBER | — |