Healthcare Provider Details

I. General information

NPI: 1891243119
Provider Name (Legal Business Name): TANYA PETERSON PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2016
Last Update Date: 01/20/2025
Certification Date: 01/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3448 S 3200 W
WEST VALLEY UT
84119-2628
US

IV. Provider business mailing address

4700 TRAMWAY BLVD NE
ALBUQUERQUE NM
87111-2979
US

V. Phone/Fax

Practice location:
  • Phone: 801-359-2256
  • Fax: 385-255-9731
Mailing address:
  • Phone: 505-292-5888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP00008404
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: