Individual
VERNON ELLIOTT PETERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RPH.
Contact information
Practice address
1007 3RD AVE, MOUNTAIN LAKE, MN 56159-1587
(507) 427-2707
(507) 427-2328
Mailing address
1007 3RD AVE, PO BOX 310, MOUNTAIN LAKE, MN 56159-0310
(507) 427-2707
(507) 427-2328
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
111199
MN
183500000X
Pharmacist
Primary
111199-8
MN
183500000X
Pharmacist
3595
SD
333600000X
Pharmacy
Primary
267371
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
111199-8
MN PHARMACIST LICENSE
MN
01
—
119330
PHARMACIST LICENSE
MN
01
—
267371
PHARMACY LICENSE
MN
Enumeration date
11/10/2005
Last updated
05/13/2026
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