Individual
MR. EVAN PETERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CPHT
Contact information
Practice address
1005 BROADWAY ST, QUINCY, IL 62301-2834
(217) 223-8400
(217) 223-2263
Mailing address
3710 BROADWAY ST # 342, QUINCY, IL 62305-2822
(636) 692-4558
Taxonomy
Speciality
Code
Description
License number
State
183700000X
Pharmacy Technician
Primary
049214411
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
049214411
PHARMACY TECHNICIAN LICENSE
IL
01
—
10015096
PHARMACY TECHNICIAN CERTIFICATION
—
Enumeration date
05/04/2021
Last updated
10/20/2023
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