Healthcare Provider Details

I. General information

NPI: 1760009039
Provider Name (Legal Business Name): LAUREN L PETERSON PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2020
Last Update Date: 08/10/2023
Certification Date: 08/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 VILLAGE DR
MILLVILLE NJ
08332-1581
US

IV. Provider business mailing address

1111 VILLAGE DR
MILLVILLE NJ
08332-1581
US

V. Phone/Fax

Practice location:
  • Phone: 856-300-2455
  • Fax:
Mailing address:
  • Phone: 856-300-2455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP451681
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number28RI03872400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: