Individual
ROYCE G PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHARMD
Contact information
Practice address
700 CAMPBELL ST, BAKER CITY, OR 97814-2212
(541) 523-0607
(541) 523-0589
Mailing address
700 CAMPBELL ST, BAKER CITY, OR 97814-2212
(541) 523-0607
(541) 523-0589
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
0012258
OR
183500000X
Pharmacist
P6405
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0012258
STATE PHARMACIST LICENSE
OR
01
—
P6405
STATE PHARMACY LICENSE
ID
Enumeration date
02/10/2012
Last updated
02/10/2012
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