Organization
PETERSON FOODTOWN INC
Active
Other names
PETERSONS PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
MONTE PETERSON RPH (PRES)
(801) 254-0761
Entity
Organization
Contact information
Practice address
1777 W 12600 S, RIVERTON, UT 84065-7043
(801) 254-0809
(801) 254-5982
Mailing address
1777 W 12600 S, RIVERTON, UT 84065-7043
(801) 254-0809
(801) 254-5982
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
6120204-1703
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4610514
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
08/10/2006
Last updated
03/22/2013
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