Active NPI
Lara Peterson, RPH
- Pharmacist
- Yakima, WA
National Provider Identifier
1063758985
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 00059649
- Practice address
- 1206 N 40TH Ave
Yakima, WA 98908-9456 - Phone
- (509) 576-6833
- NPI assigned
- Dec 20, 2012
- Last updated
- Dec 20, 2012
- Sex
- Female
- 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 | 00059649 | WA | Primary |
Addresses
Primary practice location
1206 N 40TH Ave
Yakima, WA 98908-9456
Mailing address
120 Echo Glenn PL
Yakima, WA 98908-8815
Phone (509) 388-8643
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 |
|---|---|---|---|
| 00059649 | WA | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Fred Meyer Stores Inc | Past | Accepting new patients | |
| Fred Meyer Stores Inc. | 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": "1355961600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1355961600000",
"number": "1063758985",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "120 ECHO GLENN PL",
"city": "YAKIMA",
"state": "WA",
"postal_code": "989088815",
"telephone_number": "509-388-8643"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1206 N 40TH AVE",
"city": "YAKIMA",
"state": "WA",
"postal_code": "989089456",
"telephone_number": "509-576-6833"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETERSON",
"first_name": "LARA",
"name_prefix": "Mrs.",
"credential": "RPH",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-12-20",
"last_updated": "2012-12-20",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "WA",
"license": "00059649",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Yakima, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 20, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.