Peacock Pharmacy LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

10993 Issued in SC

Legal business name

PEACOCK PHARMACY LLC

Doing business as

Peacock Pharmacy,LLC

Practice address

550 S Church St Ste 9
Spartanburg, SC 29306-3306

Phone

(864) 596-4501

Fax

(864) 596-4503

NPI assigned

May 11, 2010

Last updated

Sep 1, 2010By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Diandra Brooks

Title

Pharmacist

Phone

(864) 596-4501

Specialties & licenses 3

Addresses

Other identifiers 1

Other names 1

• Peacock Pharmacy,LLC Doing business as

Tax ID family

Peacock Pharmacy LLC3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

• Peacock Pharmacy LLC

  • Community/Retail Pharmacy
  • Spartanburg, SC
  • NPI 1699086546
  NPD tax ID
• Peacock Pharmacy LLC

  • Community/Retail Pharmacy
  • Duncan, SC
  • NPI 1952612848
  NPD tax ID

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1273536000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1283299200000",
    "number": "1942528278",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1201 HIGHWAY 37 19E",
            "address_2": "SUITE 3",
            "city": "ELIZABETHTON",
            "state": "TN",
            "postal_code": "376434678",
            "telephone_number": "423-542-2195"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "550 S CHURCH ST STE 9",
            "city": "SPARTANBURG",
            "state": "SC",
            "postal_code": "293063306",
            "telephone_number": "864-596-4501",
            "fax_number": "864-596-4503"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEACOCK PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-05-11",
        "last_updated": "2010-09-01",
        "status": "A",
        "authorized_official_last_name": "BROOKS",
        "authorized_official_first_name": "DIANDRA",
        "authorized_official_title_or_position": "PHARMACIST",
        "authorized_official_telephone_number": "864-596-4501"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "SC",
            "license": "10993",
            "primary": true
        },
        {
            "code": "3336M0002X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Mail Order Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP PROVIDER IDENTIFICATION NUMBER",
            "identifier": "4229680",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Peacock Pharmacy,LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Peacock Pharmacy LLC
• Delisah A Peake, BS
• Peaock Medical Equipment & Home Health Care LLC
• Jamila K Pearson
• Elijah Edward Pecheny, CRNA
• Marianne Pedersen, OTR/L

• Community/Retail Pharmacy in Spartanburg, SC
• Providers in Spartanburg, SC by specialty
• Community/Retail Pharmacy in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 1, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.