Individual
ANTHONY LEE PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHARMD.
Contact information
Practice address
427 N 12TH STREET, PLUMMER, ID 83851
(208) 686-5081
(208) 688-6611
Mailing address
427 N 12TH STREET, PO BOX 388, PLUMMER, ID 83851
(208) 686-5081
(208) 688-6611
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
17946
MT
Other
Enumeration date
07/17/2013
Last updated
01/15/2019
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