Individual
PATRICIA PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
R.PH.
Contact information
Practice address
1105 MICHIGAN AVE, OROFINO, ID 83544-2625
(208) 476-5727
Mailing address
22500 ANGEL RIDGE RD, PECK, ID 83545-8059
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
P5043
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P5043
STATE PHARMACIST LICENSE
ID
Enumeration date
02/07/2007
Last updated
07/08/2007
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