Provider Demographics
NPI:1154621878
Name:MCINTYRE, PETER LESLIE (RPH)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:LESLIE
Last Name:MCINTYRE
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3955 MISSOURI FLAT RD
Mailing Address - Street 2:
Mailing Address - City:PLACERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95667-5208
Mailing Address - Country:US
Mailing Address - Phone:530-295-2977
Mailing Address - Fax:530-295-2981
Practice Address - Street 1:3955 MISSOURI FLAT RD
Practice Address - Street 2:
Practice Address - City:PLACERVILLE
Practice Address - State:CA
Practice Address - Zip Code:95667-5208
Practice Address - Country:US
Practice Address - Phone:530-295-2977
Practice Address - Fax:530-295-2981
Is Sole Proprietor?:No
Enumeration Date:2010-10-27
Last Update Date:2010-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH39101183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist