Provider Demographics
NPI:1528160124
Name:MOTT, PEGGY BYNUM (RPH)
Entity type:Individual
Prefix:
First Name:PEGGY
Middle Name:BYNUM
Last Name:MOTT
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:PEGGY
Other - Middle Name:BYNUM
Other - Last Name:WOOSLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5780 S PEORIA AVENUE
Mailing Address - Street 2:PPAEO INC
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74105-7857
Mailing Address - Country:US
Mailing Address - Phone:918-858-5200
Mailing Address - Fax:918-582-4921
Practice Address - Street 1:125 E TOWNSHIP
Practice Address - Street 2:SUITE 1
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-2817
Practice Address - Country:US
Practice Address - Phone:479-443-7791
Practice Address - Fax:479-443-5761
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD05284183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist