Organization
PEACOCK PHARMACY LLC
Active
Other names
Peacock Pharmacy,LLC
Organization subpart
No
Provider details
NPI number
Authorized official
DIANDRA BROOKS (PHARMACIST)
(864) 596-4501
Entity
Organization
Contact information
Practice address
550 S CHURCH ST STE 9, SPARTANBURG, SC 29306-3306
(864) 596-4501
(864) 596-4503
Mailing address
1201 HIGHWAY 37 19E, SUITE 3, ELIZABETHTON, TN 37643-4678
(423) 542-2195
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
10993
SC
3336M0002X
Mail Order Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4229680
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
05/11/2010
Last updated
09/01/2010
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