Healthcare Provider Details

I. General information

NPI: 1245658095
Provider Name (Legal Business Name): KAMERON PETERSON PHARMD, BCACP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2014
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

640 E MAIN ST
SUN PRAIRIE WI
53590-9696
US

IV. Provider business mailing address

640 E MAIN ST
SUN PRAIRIE WI
53590-9696
US

V. Phone/Fax

Practice location:
  • Phone: 608-837-3821
  • Fax:
Mailing address:
  • Phone: 608-837-3821
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number15903-40
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: