Provider Demographics
NPI:1871558395
Name:PECK, GARY MARTIN (RPH)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:MARTIN
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 1:346 DEWALD LN
Mailing Address - Street 2:
Mailing Address - City:HUGHESVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17737-8680
Mailing Address - Country:US
Mailing Address - Phone:570-584-5453
Mailing Address - Fax:570-584-5453
Practice Address - Street 1:2195 STATE ROUTE 442
Practice Address - Street 2:
Practice Address - City:MUNCY
Practice Address - State:PA
Practice Address - Zip Code:17756-7600
Practice Address - Country:US
Practice Address - Phone:570-546-8272
Practice Address - Fax:570-546-5224
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-18
Last Update Date:2012-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP027619L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PARP027619LOtherPHARMACIST LICENSE