Individual
DALE JUSTIN PETERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
401 E IVY RD UNIT 3, TEA, SD 57064-2649
(605) 940-4620
Mailing address
401 E IVY RD UNIT 3, TEA, SD 57064-2649
(605) 940-4620
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
5088
SD
Other
Enumeration date
05/25/2021
Last updated
05/25/2021
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