Individual
GERALD R PETERSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
R.PH.
Contact information
Practice address
4401 HARRISON BLVD, OGDEN, UT 84403-3195
(801) 387-7500
(801) 387-7505
Mailing address
1258 ALLANWOOD RD, LAYTON, UT 84040-3435
(801) 546-6419
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
148544-1701
UT
Other
Enumeration date
07/10/2006
Last updated
07/08/2007
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