Johnny B Peebles, PHARMACIST
Individual provider Active NPI Pharmacist · Choctaw, MS
NPI 1881809655 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1881809655
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- E05061 (MS)
- Practice address
- 210 Hospital Cir
Choctaw, MS 39350-6781 - Phone
- (601) 656-2211
- Fax
- (601) 663-7721
- NPI assigned
- May 14, 2007
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| E05061 | MS | MD | Pharmacist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | E05061 | MS | Yes |
Addresses
Primary practice location
210 Hospital Cir
Choctaw, MS 39350-6781
Mailing address
210 Hospital Cir
Choctaw, MS 39350-6781
Phone (601) 656-2211
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| E05061 | Other | MS | LICENSE |
Other providers in Choctaw, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.