Provider Demographics
NPI:1306057781
Name:KRECKEL, PETER ALBERT (RPH)
Entity type:Individual
Prefix:MR
First Name:PETER
Middle Name:ALBERT
Last Name:KRECKEL
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 1:2329 BROAD AVE
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16601
Mailing Address - Country:US
Mailing Address - Phone:814-943-1310
Mailing Address - Fax:814-943-2841
Practice Address - Street 1:2329 BROAD AVE
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16601
Practice Address - Country:US
Practice Address - Phone:814-943-1310
Practice Address - Fax:814-943-2841
Is Sole Proprietor?:No
Enumeration Date:2007-05-25
Last Update Date:2010-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP031811L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist