Organization
PEACOCK PHARMACY LLC
Active
Other names
Peacock Pharmacy LLC
Organization subpart
No
Provider details
NPI number
Authorized official
ADAM WELLINGTON (PRESIDENT)
(423) 547-3224
Entity
Organization
Contact information
Practice address
8147 WARREN H ABERNATHY HWY, SPARTANBURG, SC 29301-2451
(864) 587-5707
Mailing address
1201 HWY 19E BYASS, SUITE 3, ELLIZABETHTON, TN 37649
(423) 547-3224
(800) 419-1565
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
—
—
3336M0002X
Mail Order Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4229731
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
06/25/2010
Last updated
07/16/2010
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