Provider Demographics
NPI:1528280807
Name:PEACOCK, JOHN CHARLES SR (RPH)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:CHARLES
Last Name:PEACOCK
Suffix:SR
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:PO BOX 613
Mailing Address - Street 2:
Mailing Address - City:BLOUNTSTOWN
Mailing Address - State:FL
Mailing Address - Zip Code:32424-0613
Mailing Address - Country:US
Mailing Address - Phone:850-674-5756
Mailing Address - Fax:850-914-9125
Practice Address - Street 1:3621 US HWY 231 NORTH
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32404
Practice Address - Country:US
Practice Address - Phone:850-914-0200
Practice Address - Fax:850-914-9125
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS10385183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist