Individual
MRS. DIANE M PETERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
R.PH.
Contact information
Practice address
321 JEFFERSON ST N, WADENA, MN 56482-1372
(218) 631-4050
(218) 631-2726
Mailing address
1026 9TH ST SW, WADENA, MN 56482-1943
(218) 631-4050
(218) 631-2726
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
112881-3
MN
183500000X
Pharmacist
4114
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
112881-3
STATE PHARMACIST LICENSE
MN
01
—
4114
STATE PHARMACIST LICENSE
SD
Enumeration date
12/01/2006
Last updated
07/08/2007
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