Active NPI
Deborah Peterson, RPH
- Pharmacist
- Pewaukee, WI
National Provider Identifier
1053931659
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 12719
- Practice address
- 2135 Silvernail Rd
Pewaukee, WI 53072-5525 - Phone
- (262) 513-9221
- NPI assigned
- Apr 23, 2020
- Sex
- Female
- Sole proprietor
- Yes
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 | 12719 | WI | Primary |
Addresses
Primary practice location
2135 Silvernail Rd
Pewaukee, WI 53072-5525
Mailing address
W290N8208 Florencetta HTS
Hartland, WI 53029-9537
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
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12719 | WI | MD | Addiction (Substance Use Disorder) Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Wisconsin CVS Pharmacy LLC | Past | Accepting new patients | |
| Wisconsin CVS Pharmacy LLC | 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 and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1587600000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1587600000000",
"number": "1053931659",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "W290N8208 FLORENCETTA HTS",
"city": "HARTLAND",
"state": "WI",
"postal_code": "530299537"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2135 SILVERNAIL RD",
"city": "PEWAUKEE",
"state": "WI",
"postal_code": "530725525",
"telephone_number": "262-513-9221"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETERSON",
"first_name": "DEBORAH",
"credential": "RPH",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-04-23",
"last_updated": "2020-04-23",
"certification_date": "2020-04-23",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Pharmacist",
"state": "WI",
"license": "12719",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pewaukee, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.