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NPI Code Detail

MEDICARE: PAUL ERIC PETERSON BS

MEDICARE: PAUL ERIC PETERSON BS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist028164MO

General Provider Information

NPI Number : 1750654224
Entity Type Code : Individual
Provider Name (Legal Business Name) : PAUL ERIC PETERSON BS
Provider Business Mailing Address
First Line : 7500 WORNALL RD
Second Line :
City : KANSAS CITY
State : MO
Zip : 64114-1816
Country : US
Telephone Number : 816-444-4179
Fax Number : 816-444-7159
Provider Business Practice Location Address
First Line : 7500 WORNALL RD
Second Line :
City : KANSAS CITY
State : MO
Zip : 64114-1816
Country : US
Telephone Number : 816-444-4179
Fax Number : 816-444-7159
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/14/2012
Last Update Date : 02/14/2012

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