Provider Demographics
NPI:1124791298
Name:EMRAL, PEGGY MAY
Entity type:Individual
Prefix:
First Name:PEGGY
Middle Name:MAY
Last Name:EMRAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 E FRONT ST
Mailing Address - Street 2:
Mailing Address - City:BUCHANAN
Mailing Address - State:MI
Mailing Address - Zip Code:49107-1458
Mailing Address - Country:US
Mailing Address - Phone:269-695-2000
Mailing Address - Fax:269-695-2931
Practice Address - Street 1:715 E FRONT ST
Practice Address - Street 2:
Practice Address - City:BUCHANAN
Practice Address - State:MI
Practice Address - Zip Code:49107-1458
Practice Address - Country:US
Practice Address - Phone:269-695-2000
Practice Address - Fax:269-695-2931
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-26
Last Update Date:2021-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5303037838183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5303037838OtherPHARMACY TECH LICENSE