Individual
CLARENCE EDSEL PEACOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RPH
Contact information
Practice address
101 LOCUST ST, LYMAN, SC 29365-1503
(864) 439-1040
(864) 949-0461
Mailing address
101 LOCUST ST, LYMAN, SC 29365-1503
(864) 439-1040
(864) 949-0461
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
3631
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3631
SOUTH CAROLINA LICENSE #3631
SC
Enumeration date
08/27/2012
Last updated
08/27/2012
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