Individual
BEN J PEACOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHARMACIST
Contact information
Practice address
US HWY 491 NORTH, SHIPROCK, NM 87420
(505) 368-7269
(505) 368-7262
Mailing address
PO BOX 160, SHIPROCK, NM 87420-0160
(505) 368-7269
(505) 368-7262
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
18305
CO
183500000X
Pharmacist
RP00007253
NM
Other
Enumeration date
04/27/2007
Last updated
11/29/2011
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