Individual
DR. KEVIN RICHARD PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHARMD RPH
Contact information
Practice address
2324 S 156TH CIR, OMAHA, NE 68130-2511
(402) 330-5482
(402) 330-2697
Mailing address
2324 S 156TH CIR, OMAHA, NE 68130-2511
(402) 330-5482
(402) 330-2697
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
11834
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11834
PHARMACY LICENSE
NE
Enumeration date
10/23/2007
Last updated
01/04/2010
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