MEDICARE: JOHN CLAYTON PETERSON PHARMACIST

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	110841	MN

General Provider Information

NPI Number	:	1578837365
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN CLAYTON PETERSON PHARMACIST

Provider Business Mailing Address
First Line	:	17719 LANDMARK CT
Second Line	:
City	:	LAKEVILLE
State	:	MN
Zip	:	55044-5229
Country	:	US
Telephone Number	:	952-898-0637
Fax Number	:	952-898-0637

Provider Business Practice Location Address
First Line	:	700 DIVISION ST S
Second Line	:
City	:	NORTHFIELD
State	:	MN
Zip	:	55057-2427
Country	:	US
Telephone Number	:	507-645-4455
Fax Number	:	507-645-6912

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

Provider Enumeration Date	:	02/27/2012
Last Update Date	:	02/27/2012

Similar Medicare Providers

1194330456 — ASTRUP DRUG INC
Practice Location Address:

700 DIVISION ST S
NORTHFIELD, MN
55057-2427

Practice Phone: 507-645-4455
Practice Fax:

1578585527 — PAULA JOY DETJEN LMFT
Practice Location Address:

706 DIVISION ST S
NORTHFIELD, MN
55057-2427

Practice Phone: 507-581-0430
Practice Fax:

1740396910 — PEDIATRIC AND YOUNG ADULT CARE
Practice Location Address:

706 SOUTH DIVISION ST
NORTHFIELD, MN
55057-2427

Practice Phone: 507-645-9534
Practice Fax: 507-645-8307

1568528156 — PAULA J. DETJEN, PLLC
Practice Location Address:

706 DIVISION ST S
NORTHFIELD, MN
55057-2427

Practice Phone: 507-581-0430
Practice Fax:

1750650016 — JAMES EUGENE GANNON PHARM.D. RPH
Practice Location Address:

700 DIVISION ST S
NORTHFIELD, MN
55057-2427

Practice Phone: 507-645-4455
Practice Fax:

1154671261 — MR. MITCHELL LEE ROLLIE
Practice Location Address:

700 DIVISION ST S
NORTHFIELD, MN
55057-2427

Practice Phone: 507-645-4455
Practice Fax: 507-645-6912

Directions to “ JOHN CLAYTON PETERSON PHARMACIST” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.