Individual
BRIANNA RAE PETERNELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
11115 W 133RD AVE, CEDAR LAKE, IN 46303-9742
(219) 374-5688
Mailing address
11115 W 133RD AVE, CEDAR LAKE, IN 46303-9742
(219) 374-5688
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
26028246A
IN
Other
Enumeration date
11/17/2020
Last updated
11/17/2020
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