Individual
MRS. CONNIE MARIE PETERSON
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
RPH
Contact information
Practice address
2351 VANDENBURG DR, ALEXANDRIA, LA 71303-5609
(318) 483-7336
(318) 483-7088
Mailing address
2310 COULEE CROSSING RD, WOODWORTH, LA 71485-9732
(318) 442-0229
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
13816
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
13816
BOARD OF PHARMACY
LA
Enumeration date
08/09/2005
Last updated
07/08/2007
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