Active NPI
Jon Tor Peterson, PHARMD
- Pharmacist
- Westminster, CO
National Provider Identifier
1063645893
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 17698
- Practice address
- 9983 Wadsworth Pkwy
Westminster, CO 80021-4249 - Phone
- (303) 467-7616
- Fax
- (303) 467-5658
- NPI assigned
- Aug 27, 2009
- Sex
- Male
- 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 | 17698 | CO | Primary |
Addresses
Primary practice location
9983 Wadsworth Pkwy
Westminster, CO 80021-4249
Mailing address
9983 Wadsworth Pkwy
Westminster, CO 80021-4249
Phone (303) 467-7616
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 17698 | CO | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Dillon Companies LLC | Past | Accepting new patients |
Organizations & group practices 1
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.
-
dba King Soopers Pharmacy #55
- Community/Retail Pharmacy
- Westminster, CO
- NPI 1023053014
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1251331200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1251331200000",
"number": "1063645893",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9983 WADSWORTH PKWY",
"city": "WESTMINSTER",
"state": "CO",
"postal_code": "800214249",
"telephone_number": "303-467-7616",
"fax_number": "303-467-5658"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9983 WADSWORTH PKWY",
"city": "WESTMINSTER",
"state": "CO",
"postal_code": "800214249",
"telephone_number": "303-467-7616",
"fax_number": "303-467-5658"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETERSON",
"first_name": "JON",
"middle_name": "TOR",
"name_prefix": "Dr.",
"credential": "PHARMD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2009-08-27",
"last_updated": "2009-08-27",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "CO",
"license": "17698",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Westminster, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.