Individual
MR. KENNETH R PETERSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RPH
Contact information
Practice address
5500 MARTIN WAY E, LACEY, WA 98516-6326
(360) 456-4057
Mailing address
5500 MARTIN WAY S.E., LACEY, WA 98516
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
PH00019664
WA
Other
Enumeration date
03/29/2012
Last updated
03/29/2012
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