Individual
MARK EUGENE PETERSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHARMD
Contact information
Practice address
140 E MAIN ST, OTHELLO, WA 99344-1040
(509) 488-5256
(509) 331-1612
Mailing address
140 E MAIN ST, OTHELLO, WA 99344-1040
(509) 488-5256
(509) 331-1612
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
PH60341057
WA
Other
Enumeration date
06/11/2013
Last updated
06/11/2013
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