NPI | 1104897982 |
---|---|
Former Name | KELLY LEANN PETERSON |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 183500000X Pharmacist (Licence: ID P6230) |
Additional Taxonomies | 183500000X Pharmacist (Licence: MT 4563) |
183500000X Pharmacist (Licence: WA PH00050019) | |
Enumeration Date | 2006-01-30 |
Last Update Date | 2020-06-24 |