Healthcare Provider Details

I. General information

NPI: 1679695035
Provider Name (Legal Business Name): JAMES ANDERS PETERSON PHARMD BCPS BCPP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/05/2007
Last Update Date: 08/30/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5203 E CORONADO CIRCLE
PHOENIX AZ
85044-2336
US

IV. Provider business mailing address

5203 E CORONADO CIR
PHOENIX AZ
85044-2336
US

V. Phone/Fax

Practice location:
  • Phone: 480-893-6908
  • Fax:
Mailing address:
  • Phone: 480-893-6908
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number9155
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number0051-036224
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code1835P1300X
TaxonomyPsychiatric Pharmacist
License Number9155
License Number StateAZ
# 4
Primary TaxonomyN
Taxonomy Code1835P1300X
TaxonomyPsychiatric Pharmacist
License Number0051-036224
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: