Healthcare Provider Details

I. General information

NPI: 1457581399
Provider Name (Legal Business Name): ERIK BRADFORD PETERSON PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2009
Last Update Date: 07/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 S 1ST ST # T119
TEMPLE TX
76504-7451
US

IV. Provider business mailing address

2800 SUNRISE RD APT 527
ROUND ROCK TX
78665-2564
US

V. Phone/Fax

Practice location:
  • Phone: 254-743-2943
  • Fax:
Mailing address:
  • Phone: 979-571-4098
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number20520
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: