Individual
MRS. STEPHANIE JEAN PETERSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHARM.D.
Contact information
Practice address
15300 GROVE CIR N, T2223, MAPLE GROVE, MN 55369-4469
(763) 447-2507
Mailing address
15300 GROVE CIR N, T2223, MAPLE GROVE, MN 55369-4469
(763) 447-2507
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
120803
MN
Other
Enumeration date
07/05/2012
Last updated
07/05/2012
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