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General NPI Number Information
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NPI Number | 1144246000
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Entity Type | Organization
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Legal Business Name | PETERSON PHARMACY INC
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Dates
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Enumeration Date | 07/14/2006
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Last Update Date | 07/10/2023
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Provider Practice Location Address
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Address Line | 727 WATER AVE
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City | HILLSBORO
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State | WI
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Zip | 54634-6229
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Country | US
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Telephone | 608-489-3141
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Fax | 608-489-2821
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Provider Business Mailing Address
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Address Line | 727 WATER AVE
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City | HILLSBORO
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State | WI
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Zip | 54634-6229
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Country | US
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Telephone | 608-489-3141
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Fax | 608-489-2821
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Authorized Official
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Title or Position | VP RDO
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Name | SELMA DZELIL
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Credential |
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Telephone | 815-715-8502
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 7133-42
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License Number State | WI
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