Healthcare Provider Details

I. General information

NPI: 1447497680
Provider Name (Legal Business Name): JAMES M PETERS R.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2009
Last Update Date: 01/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3318 MAIN STREET
MEXICO NY
13114
US

IV. Provider business mailing address

3318 MAIN STREET
MEXICO NY
13114
US

V. Phone/Fax

Practice location:
  • Phone: 315-963-0601
  • Fax: 315-963-0601
Mailing address:
  • Phone: 315-963-0601
  • Fax: 315-963-0601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number036964
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: