Healthcare Provider Details

I. General information

NPI: 1386008639
Provider Name (Legal Business Name): TERITA PETERSON R.PH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2016
Last Update Date: 04/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7930 WOODLAND CENTER BLVD SUITE 500
TAMPA FL
33614-2436
US

IV. Provider business mailing address

PO BOX 99794
CHICAGO IL
60696-7594
US

V. Phone/Fax

Practice location:
  • Phone: 813-881-0949
  • Fax: 813-884-8782
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS39426
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: