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General NPI Number Information
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NPI Number | 1427323146
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Entity Type | Individual
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Provider Name | ALEX MICHAEL PETERSON PHARM. D
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Gender | Male
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Dates
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Enumeration Date | 03/13/2012
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Last Update Date | 03/13/2012
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Provider Practice Location Address
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Address Line | 6720 NE 84TH ST
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City | VANCOUVER
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State | WA
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Zip | 98665-2016
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Country | US
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Telephone | 360-828-2289
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Fax |
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Provider Business Mailing Address
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Address Line | 13717 NW 2ND AVE APT 64
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City | VANCOUVER
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State | WA
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Zip | 98685-1901
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Country | US
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Telephone | 702-217-2135
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Fax |
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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 | 17637
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License Number State | NV
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 18355
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License Number State | CO
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Taxonomy #3
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | PH 60196181
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License Number State | WA
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Taxonomy #4
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 12862
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License Number State | OR
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