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General NPI Number Information
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NPI Number | 1467520023
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Entity Type | Individual
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Provider Name | DIANE M PETERS R.PH.
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Gender | Female
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Dates
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Enumeration Date | 12/01/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 321 JEFFERSON ST N
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City | WADENA
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State | MN
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Zip | 56482-1372
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Country | US
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Telephone | 218-631-4050
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Fax | 218-631-2726
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Provider Business Mailing Address
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Address Line | 1026 9TH ST SW
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City | WADENA
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State | MN
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Zip | 56482-1943
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Country | US
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Telephone | 218-631-4050
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Fax | 218-631-2726
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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 | 112881-3
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License Number State | MN
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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 | 4114
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License Number State | SD
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