Individual
KEVEN PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
1835P0018X
Contact information
Practice address
2490 NE HIGHWAY 99W, MCMINNVILLE, OR 97128-9204
(503) 435-3125
(503) 435-3128
Mailing address
1655 NW 23RD ST, MCMINNVILLE, OR 97128-6601
(503) 857-0677
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
RPH-0014096
OR
1835P0018X
Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
RPH-0014096
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
RPH-0014096
PHARMACY
—
Enumeration date
08/05/2015
Last updated
12/24/2015
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