Healthcare Provider Details

I. General information

NPI: 1477601698
Provider Name (Legal Business Name): ANDREW M PETERSON PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

508 GARWOOD DR
CHERRY HILL NJ
08003-3406
US

IV. Provider business mailing address

508 GARWOOD DR
CHERRY HILL NJ
08003-3406
US

V. Phone/Fax

Practice location:
  • Phone: 856-427-6785
  • Fax:
Mailing address:
  • Phone: 856-427-6785
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP038605L
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: