Provider Demographics
NPI:1396067674
Name:WING, PETER C (PHARMD)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:C
Last Name:WING
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 315
Mailing Address - Street 2:
Mailing Address - City:PALATINE BRIDGE
Mailing Address - State:NY
Mailing Address - Zip Code:13428-0315
Mailing Address - Country:US
Mailing Address - Phone:518-673-3713
Mailing Address - Fax:518-673-5453
Practice Address - Street 1:9 E GRAND ST
Practice Address - Street 2:
Practice Address - City:PALATINE BRIDGE
Practice Address - State:NY
Practice Address - Zip Code:13428-2401
Practice Address - Country:US
Practice Address - Phone:518-673-3713
Practice Address - Fax:518-673-5453
Is Sole Proprietor?:No
Enumeration Date:2010-02-27
Last Update Date:2014-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY053987183500000X
MAPH27496183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist