Peterson Pharmacy Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

7133-42 Issued in WI

Legal business name

PETERSON PHARMACY INC

Doing business as

Peterson Pharmacy

Practice address

727 Water Ave
Hillsboro, WI 54634-6229

Phone

(608) 489-3141

Fax

(608) 489-2821

NPI assigned

Jul 14, 2006

Last updated

Jul 10, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Selma Dzelil

Title

VP Rdo

Phone

(815) 715-8502

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• PETERSON PHARMACY Doing business as

Medicare fee-for-service enrollment

Enrolled in WI

Enrollment records 1

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Andrew Nuzum Peterson, R.PH.

  • Pharmacist
  • Hillsboro, WI
  • NPI 1578614897
  NPD
• Jumana Swenson

  • Pharmacist
  • Hillsboro, WI
  • NPI 1073921227
  NPD (past)

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

{
    "created_epoch": "1152835200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1688947200000",
    "number": "1144246000",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "727 WATER AVE",
            "city": "HILLSBORO",
            "state": "WI",
            "postal_code": "546346229",
            "telephone_number": "608-489-3141",
            "fax_number": "608-489-2821"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "727 WATER AVE",
            "city": "HILLSBORO",
            "state": "WI",
            "postal_code": "546346229",
            "telephone_number": "608-489-3141",
            "fax_number": "608-489-2821"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PETERSON PHARMACY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-14",
        "last_updated": "2023-07-10",
        "certification_date": "2023-07-10",
        "status": "A",
        "authorized_official_last_name": "DZELIL",
        "authorized_official_first_name": "SELMA",
        "authorized_official_title_or_position": "VP RDO",
        "authorized_official_telephone_number": "815-715-8502"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "WI",
            "license": "7133-42",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2115157",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "33175900",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PETERSON PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "PETERSON PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Katherine Anne O'Rourke, DO
• Laurie Ann Orr, OTA
• Janelle Marie Osborne, P.T.A.
• Lisa Padberg, RN
• Kelli L Pasch, NP
• Peterson Pharmacy Inc
• Andrew Nuzum Peterson, R.PH.
• Joseph Roger Peterson, M.D.
• Nicholas L Rabe, CRNA
• Thomas K Resan, MD

• Community/Retail Pharmacy in Hillsboro, WI
• Providers in Hillsboro, WI by specialty
• Community/Retail Pharmacy in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.