Individual
KELVIN LEE PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RPH
Contact information
Practice address
417 STARLITE DR, PUEBLO, CO 81005-2685
(719) 564-6010
Mailing address
417 STARLITE DR, PUEBLO, CO 81005-2685
(719) 564-6010
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
10568
CO
Other
Enumeration date
11/30/2010
Last updated
11/30/2010
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