Provider Demographics
NPI:1053743138
Name:PEACOCK, ABBY LEE (PHARMD)
Entity type:Individual
Prefix:
First Name:ABBY
Middle Name:LEE
Last Name:PEACOCK
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 SPEARS CREEK CHURCH RD
Mailing Address - Street 2:APT 603
Mailing Address - City:ELGIN
Mailing Address - State:SC
Mailing Address - Zip Code:29045-8299
Mailing Address - Country:US
Mailing Address - Phone:478-231-8339
Mailing Address - Fax:
Practice Address - Street 1:175 FORUM DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29229-7938
Practice Address - Country:US
Practice Address - Phone:803-699-7067
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-31
Last Update Date:2013-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC14285183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist