Provider Demographics
NPI:1386976306
Name:PECK, WILLIAM E (RPH)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:E
Last Name:PECK
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 1:537 S MAIN ST
Mailing Address - Street 2:PO BOX 398
Mailing Address - City:CENTRAL SQUARE
Mailing Address - State:NY
Mailing Address - Zip Code:13036-3500
Mailing Address - Country:US
Mailing Address - Phone:315-668-2659
Mailing Address - Fax:
Practice Address - Street 1:537 S MAIN ST
Practice Address - Street 2:
Practice Address - City:CENTRAL SQUARE
Practice Address - State:NY
Practice Address - Zip Code:13036-3500
Practice Address - Country:US
Practice Address - Phone:315-668-2659
Practice Address - Fax:315-676-5256
Is Sole Proprietor?:No
Enumeration Date:2010-02-01
Last Update Date:2010-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY040269183500000X
FLPS-30965183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist