# PETERSON FOODTOWN INC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Other names:** PETERSONS PHARMACY
- **Organization subpart:** No

## Provider details

- **NPI number:** 1598776148
- **Authorized official:** MONTE PETERSON RPH (PRES)
- **Authorized official phone:** (801) 254-0761

## Contact information

- **Practice address:** 1777 W 12600 S, RIVERTON, UT 84065-7043
- **Practice address phone:** (801) 254-0809
- **Practice address fax:** (801) 254-5982
- **Mailing address:** 1777 W 12600 S, RIVERTON, UT 84065-7043
- **Mailing address phone:** (801) 254-0809
- **Mailing address fax:** (801) 254-5982

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | 6120204-1703 | UT | Yes |

## Other

- **Enumeration date:** 08/10/2006
- **Last updated:** 03/22/2013

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 4610514 | NCPDP PROVIDER IDENTIFICATION NUMBER | — |