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Individual
ROYCE G PETERSON
Active
Individual
ROYCE G PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHARMD
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
0012258
OR
183500000X
Pharmacist
P6405
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0012258
STATE PHARMACIST LICENSE
OR
01
—
P6405
STATE PHARMACY LICENSE
ID
Enumeration date
02/10/2012
Last updated
02/10/2012
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