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General NPI Number Information
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NPI Number | 1215535448
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Entity Type | Individual
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Provider Name | KIKELOMO PETERS PHARMD
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Gender | Female
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Dates
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Enumeration Date | 10/09/2020
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Last Update Date | 10/09/2020
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Provider Practice Location Address
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Address Line | 4107 CROSSPOINT BLVD STE B
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City | EDINBURG
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State | TX
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Zip | 78539-1805
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Country | US
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Telephone | 832-277-0370
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Fax | 956-292-0416
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Provider Business Mailing Address
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Address Line | 4107 CROSSPOINT BLVD STE B
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City | EDINBURG
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State | TX
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Zip | 78539-1805
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Country | US
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Telephone | 832-419-3267
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Fax | 956-292-0416
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 45723
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License Number State | TX
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