Individual
MR. JOHN G PETERSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RPH
Contact information
Practice address
193 N BROADWAY, PENNSVILLE, NJ 08070-1417
(856) 678-2122
Mailing address
4 HARVARD AVE, BLACKWOOD, NJ 08012-2510
(856) 232-0230
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
28RI01431300
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
28RI01431300
PHARMACIST LICENSE
NJ
Enumeration date
08/20/2006
Last updated
07/08/2007
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