Healthcare Provider Details

I. General information

NPI: 1164407664
Provider Name (Legal Business Name): AMBER L PELTIER PHARMD.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/07/2005
Last Update Date: 12/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8600 NICOLLET AVE S
BLOOMINGTON MN
55420-2824
US

IV. Provider business mailing address

632 HERITAGE WAY
FARMINGTON MN
55024-1616
US

V. Phone/Fax

Practice location:
  • Phone: 952-887-6600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number118437-8
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number19851
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: