Provider Demographics
NPI:1528403268
Name:MCPEAK, NIKKI ANNE (RPH, CDOE, CVDOE)
Entity type:Individual
Prefix:
First Name:NIKKI
Middle Name:ANNE
Last Name:MCPEAK
Suffix:
Gender:F
Credentials:RPH, CDOE, CVDOE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 MARK GLEN CT
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02881-1611
Mailing Address - Country:US
Mailing Address - Phone:401-741-9250
Mailing Address - Fax:
Practice Address - Street 1:3 MARK GLEN CT
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:RI
Practice Address - Zip Code:02881-1611
Practice Address - Country:US
Practice Address - Phone:401-741-9250
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133NN1002X
RI4141183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education