Individual
MR. BRENT H PEACOCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1425 S HIGHWAY 89, JACKSON, WY 83001-4330
(307) 733-8746
(307) 733-8824
Mailing address
PO BOX 11124, JACKSON, WY 83002-1124
(307) 734-1917
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
2773
WY
Other
Enumeration date
10/25/2010
Last updated
10/25/2010
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