Provider Demographics
NPI:1316536436
Name:PELUSO, PAETON MAE (CPHT)
Entity type:Individual
Prefix:
First Name:PAETON
Middle Name:MAE
Last Name:PELUSO
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:482 KELLY RD
Mailing Address - Street 2:
Mailing Address - City:TROUT RUN
Mailing Address - State:PA
Mailing Address - Zip Code:17771-8844
Mailing Address - Country:US
Mailing Address - Phone:570-974-4852
Mailing Address - Fax:
Practice Address - Street 1:1916 LYCOMING CREEK RD
Practice Address - Street 2:
Practice Address - City:WILLIAMSPORT
Practice Address - State:PA
Practice Address - Zip Code:17701-1205
Practice Address - Country:US
Practice Address - Phone:570-326-5144
Practice Address - Fax:570-326-7166
Is Sole Proprietor?:No
Enumeration Date:2021-01-13
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician