Provider Demographics
NPI:1104459189
Name:PEACOCK, ERIN (PHARMD)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:PEACOCK
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 STONEBRIDGE XING
Mailing Address - Street 2:
Mailing Address - City:PERRY
Mailing Address - State:GA
Mailing Address - Zip Code:31069-4982
Mailing Address - Country:US
Mailing Address - Phone:478-988-8398
Mailing Address - Fax:478-988-0115
Practice Address - Street 1:1367 SAM NUNN BLVD
Practice Address - Street 2:
Practice Address - City:PERRY
Practice Address - State:GA
Practice Address - Zip Code:31069-2121
Practice Address - Country:US
Practice Address - Phone:478-988-8398
Practice Address - Fax:478-988-0115
Is Sole Proprietor?:No
Enumeration Date:2020-02-18
Last Update Date:2020-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH0239431835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist