MEDICARE: STEVEN PETERSEN JR.

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	S026171	AZ

General Provider Information

NPI Number	:	1821709460
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEVEN PETERSEN JR.

Provider Business Mailing Address
First Line	:	6313 E ROCHELLE ST
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85215-0709
Country	:	US
Telephone Number	:	602-690-8294
Fax Number	:

Provider Business Practice Location Address
First Line	:	150 E OLD WEST HWY
Second Line	:
City	:	APACHE JUNCTION
State	:	AZ
Zip	:	85119-0002
Country	:	US
Telephone Number	:	480-288-2143
Fax Number	:	480-982-6245

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

Provider Enumeration Date	:	12/05/2022
Last Update Date	:	12/05/2022

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Directions to “ STEVEN PETERSEN JR. ” Practice Location

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