Active NPI
Jacob John Peterson, PHARMD
- Pharmacist
- Waterloo, IA
National Provider Identifier
1154939262
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 22766
- Practice address
- 1825 Logan Ave
Waterloo, IA 50703-1916 - Phone
- (319) 235-3510
- NPI assigned
- Jul 15, 2020
- Sex
- Male
- 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 | 22766 | IA | Primary |
Addresses
Primary practice location
1825 Logan Ave
Waterloo, IA 50703-1916
Mailing address
4328 Paddington Dr
Cedar Falls, IA 50613-8917
Phone (319) 830-7471
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 |
|---|---|---|---|
| 22766 | IA | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1594771200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1594771200000",
"number": "1154939262",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4328 PADDINGTON DR",
"city": "CEDAR FALLS",
"state": "IA",
"postal_code": "506138917",
"telephone_number": "319-830-7471"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1825 LOGAN AVE",
"city": "WATERLOO",
"state": "IA",
"postal_code": "507031916",
"telephone_number": "319-235-3510"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETERSON",
"first_name": "JACOB",
"middle_name": "JOHN",
"credential": "PHARMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-07-15",
"last_updated": "2020-07-15",
"certification_date": "2020-07-15",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "IA",
"license": "22766",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Waterloo, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 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.