Active NPI
Justin Robert Peterson, PHARMD, RPH
- Pharmacist
- Osage Beach, MO
National Provider Identifier
1043942865
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 2022023819
- Practice address
- 3938 Osage Beach Pkwy
Osage Beach, MO 65065-2146 - Phone
- (573) 348-5081
- NPI assigned
- Jun 29, 2022
- Last updated
- Jun 29, 2022
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 2022023819 | MO | Primary |
Addresses
Primary practice location
3938 Osage Beach Pkwy
Osage Beach, MO 65065-2146
Mailing address
3938 Osage Beach Pkwy
Osage Beach, MO 65065-2146
Phone (573) 348-5081
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Pharmacy, Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2022023819 | MO | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Past | Accepting new patients | |
| Walgreen Co | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1656460800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1656460800000",
"number": "1043942865",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3938 OSAGE BEACH PKWY",
"city": "OSAGE BEACH",
"state": "MO",
"postal_code": "650652146",
"telephone_number": "573-348-5081"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3938 OSAGE BEACH PKWY",
"city": "OSAGE BEACH",
"state": "MO",
"postal_code": "650652146",
"telephone_number": "573-348-5081"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETERSON",
"first_name": "JUSTIN",
"middle_name": "ROBERT",
"credential": "PHARMD, RPH",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2022-06-29",
"last_updated": "2022-06-29",
"certification_date": "2022-06-29",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MO",
"license": "2022023819",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Osage Beach, MO
- Kiarra Kay Pearcy, MSN, FNP
- Leanne Nikole Pearson, PTA
- Chelsea Megan Pendleton, APRN
- Katharine Elise Percell, OT LIMITED
- Petersen Health Operations, LLC (Ozark Rehabilitation & Health Care)
- Howard A Peth Jr., M.D.
- Robert Ara Petrossian, MD
- Victor M. Phillips, M.D.
- Pike Chiropractic
- Pike Chiropractic LLC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 29, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.