Individual
JERRY WAYNE PEACOCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RPH
Contact information
Practice address
2681 W REPUBLIC RD, SPRINGFIELD, MO 65807-4006
(417) 877-8540
(417) 877-8541
Mailing address
2681 W REPUBLIC RD, SPRINGFIELD, MO 65807-4006
(417) 877-8540
(417) 877-8541
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
27824
MO
Other
Enumeration date
09/29/2011
Last updated
09/29/2011
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