Conner Peterson, PHARMD

Primary specialty

PharmacistTaxonomy code 183500000X

License

P7602 Issued in ID

Practice address

455 S Broadway Ave
Boise, ID 83702-7643

Phone

(208) 331-4187

NPI assigned

Jul 27, 2016

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Pharmacy

State licenses

Practice roles

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.

• Walgreen Co

  • Pharmacy
  • Boise, ID
  • NPI 1447508387
  NPD (past)
• Walgreen Co

  • Pharmacy
  • Longview, TX
  • NPI 1629956545
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1469577600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1469577600000",
    "number": "1104379064",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "455 S BROADWAY AVE",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837027643",
            "telephone_number": "208-331-4187"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "455 S BROADWAY AVE",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837027643",
            "telephone_number": "208-331-4187"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "CONNER",
        "credential": "PHARMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2016-07-27",
        "last_updated": "2016-07-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "ID",
            "license": "P7602",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Peterson Thrive Therapy
• Lauri Peterson Peterson-Carey
• Andrew Albert Peterson, M.D.
• Anna Jeannette Peterson, DO
• Christian Peterson, MD
• Forrest Read Peterson
• Jamie Brooke Peterson, PA-C
• Janelle Elise Peterson, LCSW
• Jennifer Elaine Peterson, LPC
• John Gregory Peterson, DMD

• Pharmacist in Boise, ID
• Providers in Boise, ID by specialty
• Pharmacist in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 27, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.