MEDICARE: DR. JESSICA A PETERSON PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	PS46185	FL

General Provider Information

NPI Number	:	1528306909
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JESSICA A PETERSON PHARMD

Provider Business Mailing Address
First Line	:	4320 DEERWOOD LAKE PKWY
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32216-1177
Country	:	US
Telephone Number	:	904-620-0599
Fax Number	:

Provider Business Practice Location Address
First Line	:	4320 DEERWOOD LAKE PKWY
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32216-1177
Country	:	US
Telephone Number	:	904-620-0599
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/20/2013
Last Update Date	:	01/20/2013

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