Provider Demographics
NPI:1104932052
Name:PEIPERT, JUDITH K (RPH)
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:K
Last Name:PEIPERT
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 1:6927 GUSHING SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:EDWARDSVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62025
Mailing Address - Country:US
Mailing Address - Phone:618-656-6789
Mailing Address - Fax:
Practice Address - Street 1:108 RANSOM ST
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:IL
Practice Address - Zip Code:62012
Practice Address - Country:US
Practice Address - Phone:618-372-3313
Practice Address - Fax:618-372-8332
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist