Provider Demographics
NPI:1962748194
Name:SOUTHPEAKE ENTERPRISES, INC.
Entity type:Organization
Organization Name:SOUTHPEAKE ENTERPRISES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:NEWMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-793-1612
Mailing Address - Street 1:113 AVONLEA DR
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23322-4249
Mailing Address - Country:US
Mailing Address - Phone:757-793-1612
Mailing Address - Fax:
Practice Address - Street 1:800 BATTLEFIELD BLVD S
Practice Address - Street 2:SUITE 105
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23322-6670
Practice Address - Country:US
Practice Address - Phone:757-793-1612
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTHPEAKE ENTERPRISES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-12-16
Last Update Date:2012-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy