MEDICARE: MRS. SVETLANA 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	03127366	OH

General Provider Information

NPI Number	:	1568732840
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SVETLANA PETERSON PHARMD

Provider Business Mailing Address
First Line	:	12465 SPERRY RD
Second Line	:
City	:	CHESTERLAND
State	:	OH
Zip	:	44026-2601
Country	:	US
Telephone Number	:	440-729-2857
Fax Number	:

Provider Business Practice Location Address
First Line	:	3020 MAYFIELD RD
Second Line	:
City	:	CLEVELAND HEIGHTS
State	:	OH
Zip	:	44118-1702
Country	:	US
Telephone Number	:	216-932-4759
Fax Number	:

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

Provider Enumeration Date	:	01/04/2012
Last Update Date	:	01/05/2012

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