Provider Demographics
NPI:1063786747
Name:PRIVRATSKY, PEGGY F (RPH)
Entity type:Individual
Prefix:
First Name:PEGGY
Middle Name:F
Last Name:PRIVRATSKY
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3274 MYSTIC LN
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97405-6244
Mailing Address - Country:US
Mailing Address - Phone:541-505-9272
Mailing Address - Fax:541-868-8859
Practice Address - Street 1:220 S SENECA RD
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97402-2725
Practice Address - Country:US
Practice Address - Phone:800-456-0681
Practice Address - Fax:541-868-8859
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-28
Last Update Date:2012-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR6132183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR6132OtherSTATE PHARMACIST LICENSE
WAPL 19419OtherSTATE PHARMACIST LICENSE