Individual
MRS. SHAUNA RENEE PETERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.PH.
Contact information
Practice address
105 EVERLEIGH CT, LEXINGTON, SC 29072-7114
(803) 520-8463
Mailing address
105 EVERLEIGH CT, LEXINGTON, SC 29072-7114
(803) 520-8463
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
11723
OK
Other
Enumeration date
10/15/2011
Last updated
10/15/2011
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