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General NPI Number Information
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NPI Number | 1487977906
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Entity Type | Individual
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Provider Name | JILL A PETERSON
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Gender | Female
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Dates
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Enumeration Date | 03/11/2010
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Last Update Date | 03/11/2010
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Provider Practice Location Address
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Address Line | 47-49 LAKE AVE. EXTENSION
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City | DANBURY
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State | CT
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Zip | 06810
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Country | US
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Telephone | 203-778-7476
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Fax |
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Provider Business Mailing Address
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Address Line | 47-49 LAKE AVE. EXTENSION
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City | DANBURY
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State | CT
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Zip | 06810
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Country | US
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Telephone |
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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 | 035760-1
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License Number State | NY
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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 | 9782
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License Number State | CT
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