Healthcare Provider Details

I. General information

NPI: 1386219632
Provider Name (Legal Business Name): TYLER CHOJIN PETERSON PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2021
Last Update Date: 05/20/2021
Certification Date: 05/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HOSPITAL DR
GARAPAN MP
96950
US

IV. Provider business mailing address

PO BOX 500409
SAIPAN MP
96950-0409
US

V. Phone/Fax

Practice location:
  • Phone: 670-234-8950
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0109
License Number StateMP

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: